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i FOR OFFICE USE: APPLICATIONsFOR SANITATION PSIMIT 'e`• '--•—'• r-•--- (Comple}einTripliea'b} ... s_ .__ Permit_No: .-:r .-.._.. --•.- 6 : , .-- al � � ---��-��-�-- This Permit Date Issued . Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: ti r JOB ADDRESS/L I N .----- , _ /-.-- . '...... _.............CENSUS TRACT .................. ' Owner's Name �F .. ---- ,tt. -•.` Address .._... ....... - ... City.. - Contractor's Name ........ J /.,_--. ..-••• ' t � '.....License# fi r *4:FFLPhone I Installation will serve: Residence r]ApartmentHouse❑ Com merciah[3TraI!ee Court 0 'Motel ❑Other_...____. . Number of living units:_...... Number of bedrooms ._ ._ .Garbage Grinder ....<)_ Lot Sizet�._ -fie raG� Water Supply: Public System and name ...............---------.........•--.......... -'--------- --•-------_._._..Private Character of soil to a depth of 3 feet: Sand❑ Silt Clay ❑ Peat❑1 Sandy Loam ❑ Clay Loam,[] Hardpan p Adobe V fill Material .... .__ If yes, type-------------------- ------- I )Plot plan, showing size of lot, location of system In relation to w4lis, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No..septic tutlk or seepage pit permitted If public sewbr is available within 200 feet,l PACKAGE TREATMENT - • ( ] SEPTIC YANK _ e..-��rte'. s.�. .`...�._ Liquid.Depth V Capacity . ......._ T—e—_[/F/�lt- So-lltAaterial. -. fit. _ .. o. Compartments y i/... ..-- Y~ P F . ., vVit bN r p G�......_. `N Distance to nearest: Wellll ......,�-1...............Foundation . Q_.-._...... Prop. Line ...o .. LEACHING LINE r}� No. of Lines .....1'W.-...._{._... Length of ch line...... ..�..�. ......-._ Total Len V �r r s �6° � - - - �aa--,�. t• 'D' Boxer . Type Filter Material -.�l,l?r.....Depth Filter Material ......./Z. !.._..-.......__:_. Distanc .f'o nearest: Well ..... �. .--.. Foundation .� Property Una ..s�r.�:........ t J SEEPAGE PIT (� Depth ..,-s��.__ Diameter ..... Number ..... :......./--- Rode Filled Yes B--iq;70 P '-- a--' -� - --!��--...--�.... Water Table Depth ----- sJ .._..__.._._. _.-._........Rock Size ... Distance td nearest: Well ... .pd__ ___________________Foundation -.�0..�..... Prop. Line ..s_�....... 'w REPAIR/ADDTTION(Prov. Sanitation Pennit5w ...................................._—.. Date ...................-............. ) Septic Tank (Specify Requirements) .........................._..................._......._............r-------___---------------------- Disposal Field (Specify Regitirimenhf ..__._ ..................... ...............---- -----------......-----------------------------------.-_...................... -------................................—............................... .................. - -- -----............... .... •---- -- --'-------___._ ........................................ (Draw existing and required addition on reverse side) (�- I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: - "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." I Signed ..... ...............................'_-.._I......._'_------------- -"_. Owner By....................-- --------_I ---- --- {� _..... Title _._ _ .�!/!It . ... ....----._.-...._.•---'--'-- (If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... C ..._. . '- ............. ................................. DATE ... ..�... c._ ._-c. _9.0_. BUILDING PERMIT ISSUED ......--- -- - - - -._-------.---••_..........................DATE........................................... ADDITIONALCOMMENTS............1,................-------'-'------------......... -......................................................... .._.......-........ t .. '--..............------ --------------- --.................. — .__....-----••--•-----..._•--•••--•'-•------..-._.-...__.._..............--•----.---------------------------•- Fnal Inspection by: ... ._._ ...................... . . -._ ..__......_r_ .J)oro ..... ( SAN JOAQUIN LOCAL HEALTH DISTRICTS E.H. 9 1-'68 Rev. SM.