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FOR OFFICE USE: %wAPPLICATION FOR SANITATION PE�/IT ,,// ------ Permit No. .7Y' 003 (Complete in Triplicate) ___ __-------------- -- -- - - - Date Issued -----_-------_--_----_----------_--__- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d cri p�h� s pli tion 's made in compliance with County Ordinance No. 549 and /existing Rule�and Regulations: J ekDESS/LQCAj10 7K) . ,/ I '; ��T S--- _-CEN S TRACT �.��•[�J- J / __J___.Phone ....Owner's Mmea Addresst6------- j�7q City:l ... .... �l�r. - --------------- ----- �e Contractor's Name - ------------- Dom`------------------- -----------------------.License # ------ ---------------- Phone ............ ----------- Installation will serve: Residence U2'Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other .-------- - ---------------------- Number of living amts:__ -. ----- Number of bedrooms __..a---._-Garbage Grinder ___ ----- Lot Size _--___-..__.__. 4 1 Water Supply: Public System and name .....-.... --- --- ----------------------------------------- ----------------- ---------------------------Private 0-- Character —Character of soil To a depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ (� Hardpan P--' 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 seepage pit permitted if public sewer is available within 200 feet,) /i PACKAGE TREATMENT SEPTIC TANK � � � ...........'T I � � - Sized----X-��'�--- x-�'-� - --- Liquid Depth --/--- ---- Capacity /G_00------ Type _- -L�` Material<:C �C fit-._ No. Com artments Distance to nearest: Well -_,6�----__-__-----...__..Foundation -_./Q_____________ Prop. Line .4: ......._....... LEACHING LINE [„J' No. of Lines __.:,1.............. Length of each line--_:i (__._. . g '�� .-_ Total Length ..�_.._ ,__..______.__.. -- 'D' Box ._�___ Type Filter Material ___�?... ....Depth Filter Material ----I:L................__...____.._..... Distance to nearest: Well _-. C _.........._ Foundation I ---------------- Property Line . ................. SEEPAGE PIT [-f' Depth --kc-�'�-- -------- Diameter Number -------.G...-_../.__._-.. Rock Filled Yes Er� No Q Water Table Depth --------- ----------._-..............._.Rock Size Distance to nearest: Well -----/!r/ _ _______________________Foundation .....1e.......... Prop. Line ............... REPAIR/ADDITION(Prev. Sanitation Permit# ........._-._------------------------------- Date -------------------___------------) Septic Tank (Specify Requirements) -t Disposal Field (Specify Requirements) ----------------I-'-------------------- -------------------------------------------------------- ------ ........... ------------------------------ -------------------------- ------ ----------------------_ ........ ---------------------------------- (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 `".'-.<M_AW------------------------------------------- --_. Owner By --------------._--- -_------------------------------------------------------------------ Title _._._....-------------------------...-._..---._.-..---------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY '-�-------------------_--------------------------- --------------_ --------------. DATE -- --------------------------------------- BUILDING PERMIT ISSUED ------- - - - ------------------------------ -A---D- -D--I-T--I-O---N--A--L- COMMEFfAV NTS T-S - - - - - - "- '- . '- - r "---- ------------ ......... - - - - ---- ----- ----------------- ------ ---------------- - - - -- ------- ..------------- Final Inspection by: ---- _ . -------------- -------------------.._Date --- -- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT w E. H. 9 1-'68 Rev. 5M Y