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- FOR OFFICE USE: APPLICATION+OR !rANITATION PERMIT . -1 � (Compiete in Triplicate) Permit No. -_.,73'�� ............................................. -------------------------------------------------- _.---. .................................._............... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �* CENSUS TRACT .....................�_._ JOB ADDRESS/LOCATION .__.77e/._GL�1IQ./.iV_e___._/_C _ Owner's Name --------Phone ....... Address ........ .�lo�-�GL�(t1lLi/� % -----------_----------- ----------- City ---- ......---- .... ---•-----•- Contractor's Name ___ e�,1, C�-��+/ ._:........License Installation will serve: Residence ❑Apartment House❑ CommercialXTraiier Court 0 Motel ❑Other------- --------------------•-------•--•--- / Number of living units:............ Number of bedroomsMpAr.-Garbage Grinder ............ Lot Size ._.._! _. ..''.. Water Supply: Public System grid name =-----------------•--•-----------. ----------..._..-• --------------------------------------•---------Privat'X Character of soil to a depth of 3 feet: Sand Q- ,Silt Clay ❑ Peat F] Sandy Loam Clay Loam D Hardpan F] Adobe C] 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 [ j -SEPTIC TANK [ j Size-_U-_-!7----------------------- -------- Liquid Depth __.573............. # _ Capacity __/__ Q 4.......Type>r3vx 4' -:. Material._�g-is.Xl No. Compartments /� ! l Distance to nearest: Well _._�Q- ---------------- ------Foundation ..____... Prop. Line ____..��_. :: LEACHING LINE [ j No. of Lines _ -_____f............... Length of each line---/�_---_____.______ Total Length f�1 ......_.._.__ 'D' Box _4C7 Type Filter Material _tK# _.Depth Filter Material ------ _ •-------------------.--..- Distance to nearest: Well ___ ...... Foundation _/0------_----- Property Line. _..... ...... SEEPAGE PIT [ ] Depth ____________________ Diameter ................ Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth .-•--•..........................................Rock Size -----------------------•-------- Distance to nearest: Well ........................................Foundation ._.----------------- Prop: Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date ............._. -----------------) SepticTank (Specify Requirements) ------ ----------------------------------------- ----------------------------------------•-----------•-------------------_----...----.----- 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 wish 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 beco s lett o Worldman's Compensation laws of California." Signed - ;-sem- - - --------------- Owner) , By ..-- Title _./�l,1"��: �. ...�........... ------- (If'.other an er) i FOR DEPENT USE ONLY APPLICATION ACCEPTED BY ---------------••-- ............................................ DATE .....Z -_--- --- 7 BUILDINGPERMIT ISSUED -------•--•-------•--•---- •-------------------------- - ••----. ......... ...-....................... ---DATE --•- ........................... ADDITIONALCOMMENTS ..........-------------_--------------------------- -----------------_-------`-------------- ---------•-- ------------------------------------_........... •-------------------------------------- -----•------.-------- ---------..........................................--..-.••--------- ---.----..--•--•----------••----------------------•---..........._. -----------•------- ---------------------------------•--•---------•-----•-- ------- - .............• ----------• ---------- . -•--•-......----•----- / 7 ------ Final Inspection by: .. -••---•---•-------------------------------------- ------.Date ,Z.. ... SAN JOAQUIN LOCAL HEALTH DISTRICT