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FOR OFFICE USE: --------------------------------------------------------- APPLiCATiON(Complete FOR SANITATION PI "`,IT Permit No: -- --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _JV :11 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: JOB ADDRESS/LOCATION . [t l / •�„ -------------40- - ---------------CEMJCTCI-P.-Y-------- Owner's Name i Address ------.�1 '' <: -- ----- - •---------------•--. Cit -------------------------------------------------------------- Contractor's Name —_____________________________License #/"- 129'4_ Phone Installation will serve: Residence []Apartment House F] Commercial :I]Trailer Court i[] Motel ❑ Other ---------------------- ------ Number of living units:___ _____ Number of bedrooms __��___-----Garbage Grinder'/-4/0--- Lot Size - ________________ _ Water Supply: Public System and name ---------------------------------------------------------...............--------------- ----------------------Private CK Character of soil to a depth of 3 feet: Sand's Silt❑ Clay [] Peat❑ Sandy Loam Q Clay Loam 0 --- Hardpan (�Adobe D 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK- ] Size_________________ ______ Liquid Depth -------------_---------- Capacity __________-- _--Capacity ---------------- Type -------------------- Material---------------------- No. Compartments -------......---- \ Distance to nearest: Well ____________________________________Foundation __-__-- --------------.Prop. Line ..........:..:..-..... LEACHING LINE [ ] No. of Lines ________________________ Length of each line---------------------------- Total Length ____--..___.- _ __-______. � 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ------------------- T Distance to nearest: Well ________________________ Foundation ________________________ Property Line ________________ ........ SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes [] No .C] .� Water Table Depth ------------------------------------- ----------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation ------------.---_-__ Prop. Line ............._........ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------_) Septic Tank (Specify Requirements) ---------------- --------------------------------------------- -g--�--------- Disposal Field (Specify Requirements) iia / -------------------------- ------- ---------------- (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, 1 shall not employ any person in such manner as`to become subject to Workman's Compensation laws of California." Signed ------------------------ Owner By ------' tP _ Title ------- ------------------------------- (If oth an owns FOR :DEPARTMENT USE ONLY APPLICATION ACCEPT-=D 8Y --- ---------------------- =----------------------•--------------------------------------- DATE ------------------- BUILDING PERMIT. ISSUED ----------------------------------------- - ------ ------------- -------------DATE -------------•----------------------------- ADDITIONAL COMMENTS - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ---------------------------------- ------------------- --------------------------------------------------------------------------------------------------------------._ ....... --------------------------------------------- - ----- Final Inspection by: ------Date - ---------------------- - -- ------- � � �j f ��I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M