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FOR OFFICE USE: F PLICATION FOR SANITATION PERhk'+' -------------I -------- !l 7l .`f ----------- ; " (Complete in Triplicate) --- Permit No. _--- This Permit Expires 1 Year From Date Issued 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 compliancewith Count Ordinance No. 5a a istin Rules and Regulations: JOB ADDRESS/LOCATION . ------ E Owner's Name - ---------------Phone Address --- Ci o i Contractor's Name ^ . = .:.. icense # U. > Phone ----------------- ------------ Installation will serve: Resi e, e ❑Apartment House Commercial ❑Trailer Court ❑ Motel F-1 Other ------------------------H------0-�- Number ------------------•-•- Number of living units:----- _----- Number of bedrooms _1`77-_.Garbdge Grinder --- _------- Lot Size ----------------------------CO___ Water Supply: Public System and name ------------------------- --•------------------------------------------ -------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ t❑ . Clay ❑ Peat❑ Sandy Loam 1❑ Clay Loam.C) Hardpan Adobe ❑ Fill Material ------------ If yes,type •--------------------------- (Plot plan, showing size of lot, location of system in relation to, wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep a pit permitted if ublic sewer is available within 200 feet,) `�1 PACKAGE TREATMENT [ ] SEPT1fC TANK [ BizeT _ __ __.. _-__--•-----__:____ Liquid Depth __rl�'...............,..... Capacity/_pt3,0 _ Type _-- _ {--- Material--- ------------------ o. Compartments ---;!7'--------_-- Distance to nearest: Well -----------.5- ------------------Foundation -----E-V----------- Prop. Line ---„S-r•-.-------�v i LEACHING LINE P No. of Lines ______ 1-------------- Length of each line------ - -la__�-------- Total Length :---/-Q.Gi --------------- 'D' Box ------------ Type Filter Material ---- ------Depth Filter Material ------ --- __� Distance to nearest: Well _____ --_ Foundation ___L'V, .___________ Property Line ---- SEEPAGE PIT [ Depth -_------�----- Diameter _ _ _._.- Number ______--�----------- Rock Filled Yes 12 o Water Table Depth -------------- ----- Size __11 ..X l__...__ Distance to nearest: Well ------------ ------------------------Foundation _____/¢__...___ Prop. Line _--X-------------- REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------- --- Date ----------------------------------1 Septic Tank (Specify Requirements) ----------------------•---------------------- ----------- -••---------------••-- -----------------------------.------------- i Disposal Field (Specify Requirements) ------------------------ •----•------------------------------------•------------------------------------------ ---------•--- ------------------------------------------------------- ---------------------------------------------------------------- - (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 San 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.” Signed -------------------------------- n - Owner / l BY ----- A_ _ .Title -- ---------------------------- (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __r: - -------------------------------------------------------------- DATE --7 ?V-------------------- BUILDING PERMIT ISSUED ----------------1,z----- ------------- --------------DATE -------------•==--------------------------- - ADDITIONAL COMMENTS ----- s _ �_;ev _._L s s "= ^' ,` F = -: ; ------•- ----------------------------------- ----- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- �cd ' ------ ---------------------------------- ----- ------ --------- --- -------------------------•----- ---------------------------------------Date iFinal Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,