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FOR OFFICE USE: - -- — , _z via ---- -------------1 '' AF':'LICATIONM.FQR ;.SANITA'�iON PERMIT T1._ : ------ 3 - (Comp in Triplicate) Permit No..II Y- 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 I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATION Owner's Name ----CENSUS TRACT �i5 f Address one - ----- = city e , r Contractor's Name _ - �" ----------------- ------.License #imp Installation will serve: ,..�,�- _�--x Phone��'�� l,6 Residence 0- partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other-.------- - , ------ ---- ------ ---------- --__ ".-_ Number of bedrooms Number of living units:_ __ ____ -__ Garbage Grinder/ Q_ Lot Size Water Supply: Public System and I • - -------------------_ Character of soil to a depth of 3 feet: Sand Silt Private ❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ ,Hardpan ❑ Adobe Fill Material _ __- _'_-___ If es ,,. Y type --------------------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: fNo septicrtank or seepage pit permitted-if public sewer is available within 200 feet,) - \ PACKAGE TREATMENT _[.,] SEPTIC TAMC ' - " Capacity/ Size_- -- -----_-_-- Liquid Depth- _a •� { p +v � TYPef� � -Material �hP ' = No. Compartments -----Z-1 1 Diiiance to nearest: Well ____ --- --- Foundation /f .`- LEACHING LINE __ Prop. Line No. df--Linies �- !"- -____ Length -of each ------ ------ Q' Box -. Total Length _2_l--------__-•-- f/ - Type Filter Mater�ialA0- 1 %pepth Filter Material '�`�_- f / 4 --------------`---•--------- Distance to nearest: Well __Xv--__ ___-__ Foundation ` SEEPAGE PIT • i -� -- ------ Property Line _� . [ l Depth --✓f1' Diameter �V_/� �'/plumber ---Z-------------------- Rock Filled Yes No [� Water Table Depth __-_ ---------------------------------- fi Rock Size ` _ Distance to nearest: Well ----F0 ------ -----------------Foundation --- D--_----- Pro Line _-- _ REPAIR/ADDITION(Prev. Sanitation ermit K# -------____________ _" - p- ----- Date Septic Tank (Specify.Requirements) -______-__---___"._ Field (Specify Requirements) ----------------- Disposal $ - _ - ---- ------ --------------------------------- '�`�' '" !� ---------- - '_r i --------. ��- �- ------ �' --- -- ----- --- - -- (Draw existing and required addition on reverse side) - f 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, ands uin Local Health District. Home owner or licen- Rules and Regulations of the Son Joaq sed agents signature certifies the following: q "1 certify that in the performance of the work for which this permit is issued, I shall not as to become subject to Workman's Compens.,ation laws of California." employ any person. in such manner Signed ------- -- ---------- ----- ---- --- ----•--- Owner - BY ---------------------------------- Title --------- --- - e� (!f othe an owner) 1 ----�--------------------------------- 0 ------- _ ____ ! FOR DEPARTMENT USE ONLY r y APPLICATION A EPTED BY _-" ✓_ BUILDING PERMIT ISSUED -- ------------- -- DATE --- ---------------------------------- - ----- 70----------------- ADDITIONAL COMMENTS _.l�t QN ----- ------ - _DATE - ------------------ ` --------- r -L -- - /D ao --------------------------------------- cc'n x- -- ------------- ------------= - ------------------- ---------- -------- ------ ------------•-- ----------------------------------------------------------- -------- Inspection b - ------------------------------ Y ------------------- - --- ---------- ------------- -------.Date --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 i-'68 Rev. 5M