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FOR OFFICE USE: APPLICATInY.F.O$ SANITATION•PERMIT Permit No.. ...Z.?........... S - ---• -•-------------_--•---..........._.._ ... (Ct,mp-ate In Triplicate) , ......._...-------•--- !....... .....-•--- ------ . —P'�-7 Date Issued ............... This Permit Expires 1 Year From Date Issued i Application is hereby made to the Local Health District for a permit to construct and install the work herein. described. his Jyt i is in corriplia C C O ance No. 5 and existing Rules and Regulations: ;. .� ��. JOB ADDRESS LOC) N .... -� - .,....-•-•• '`�� :-...CEN51�S TRACT .. ....��`` Owner's Name _..t.� J--.� :................................ .--- ... --.Phone .......--------............•-------- e Address •---39.-- 57 :..,..P11-41-f=.....-•---•............. ••--------- City • _... . ------------ ----------------------------------- Contractor's Name....... .`...... = __...........................-License#�. / 1 Phone --�=�-- Installation will serve: Residence RA rtment House 0-Commercial oTrailer Court ;Q *Motel []Other .._.-----------__--------------- Number of living units_.......... Number of bedrooms ............Garbage Grinder ------------ Lot Size ._'........ �'---.•---•••-•---•-- Water Supply: Public System and name ":;::_ •-•---------•-----•----- Private ❑ » Character of soil to a depth of 3 feet: Sand'F.1 Silt❑ ._:Clay. ❑- _Peat Q Sandy Loam�Q _ Clgy L�oam:j� Hardpan ❑ Adobe'❑ Fill Material ............ yes,type ..--_--..--..---_--•-i--- (Plot plan, showing size of lot, location of system in relation to wells, buildingss,etc. must be ]aced on reverse side.) ;NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,)` -PACKAGE TREATMENT [ ] SEPTIC TANK / ize.-.. _- . . �. -`.---� -�----- Liquid Depfih ': Z.......•.._. i tom �L-t 1,.��..G ^ 10. Compartments Capacity,__..). _. Type Material. _ -' "• Distance-'to nearest: Well -- --•-- .............Foundation -•-- -----.._..... Prop. Line --------�..._-------- f 4ACHING LINE No. of Lines ..:)........---. Length of each I;ne.��.t> j/� .•---•-. Total Length...............• i �i 'D' Bax Type Filter Material 3P .....Depth Filter Material .-.,,ly..............I... y f ' Distanc to nearest: Well _...7.0......... Foundation ... . ..........•. Property Line _. .�............ I -� Number _..... - .------ -- ....... Rock Rock Filled Yes j[ __ o f❑ SEEPAGE PIT �j Depth ._...._.. Diameter ................ - -� � Rock Size .. 1 Water Table Depth ._..... . r�.r ' - i Distance to nearest: Well ------/.r~`rT.._.../.................Foundation ...1 /f Prop. Line_.'._._.�_.......... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ....:..........-__.-.............. } Septic Tank (Specify Requirements) ------_--------_----------.................•--•------•---•---•------------•-----•t-------••------•---: ------------------------- I r Disposal Field (Specify Requirements) ................ --•---•--•-•----•---............-- .............•....................................................... r t .f ................... ----•-----•-- ---------------------I................. �. �. ..� __ _ =- --- "--- ---_- -----•----.................................. ..... .......... ............. --•---• ............. -••---•--•-................. •-•--•----•-------.--•-- ^ [Draw existing and required addition on reverse side) I hereby certify that 1 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 liven- sed agents signature certifies the following: "1 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'toorkman's Compensation laws of California." Signed .------•----- r ( ----••---...... Owner ---•-----.�------- - -- ----------•---•--}}----�--�----...----•--•------ k '• =---------- Title . ..f'......... ........................... .... (If other t n ow er) } FOR EPAVME SE ONLY - - — DATE _7- ---•-- ... - ACCEPTED Y. "-------- APPLICATION BUILDING PERMIT ISSUED'....... .-•-• r ... ...�.. .. _-•--• .................DATE ------------------------------------ ADDITIONALCOMMENTS .__'.!..................... ................................................... .............. ...................... .. ....•-.. -•-•----••- -----------••----- •--•---------•---•........_ = �--------- - � r� � Final Inspection by: - ;eE _•� ': = •• ... ••....Date - _...... ...... ............ SAN JOAQUIN LOCAL HEALTH DISTRICT c u 0 1-'68 Rev. 5M