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FOR OFFICE USE: r. APPILfCA710N FOR SANITATION PERMIT Permit N�I"---•-- 5.4---- (Complete in Triplicate) p ------:-- L = " �*. Date Issued �-�ar---_---�-J This Permit Expires l Year From Date Issued 4 a 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: �` r CENSUS TRACT JOB ADDRESS/LOCA? N _QC-� J7 . ----------- ---- Owner's Name ---------------------- Phone 94-6 f1 ---- - 9 Address . 4 6-- c city r� Contractors Name .-- :---------.License# o- ---- Phone - --_ --'---••-- r�r- „3! Installation will serve: Residence ❑Apartm'ent/HousegCommercial :❑Trailer Court ❑ Mote! ❑Other -------------------------------------------- Number ----------------------------- ----- ------Number of living it -4;� Number,of.b oo s '©�.-- lG� .; Private ❑ Water Supply: Public System and name -----__ ------- �y - Garba a Grinder -----_--_ of Size _- _- i Character of soil to a depth of 3 feet': -•'Sand'❑ Sit ❑ Clay ❑� Peat❑ �Sandy Loam ❑ Clay„Loam "❑ Hardpan ❑ + 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.) t f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size---------------------------------------- ------- Liquid Depth -------------------------- f Capacity ---- --------------- Type ------------- ------ Material--------------------- No. Compartments ------------------ `W, . Distance to nearest: Well ------------------------------------Foundation ----------------------Prop. Line ---------------------- V LEACHING LINE , [ ] No. of Lines ------------------------ Length of each line------ --------------- Tota! Length ;-------- . _-i---------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---.---------------•------------------- i' jDistance to nearest: Well ------------------------ Foundation --------------=--=------ Property Line ------------------------ SEEPAGE PIT [ ] Depth -------------------- Diameter --------------- Number ------------------------ Rock Filled Yes E] No 0 Water Table Depth ---------Rock Size ------------------------------ - . Distance to nearest: Well ---------------------- -----------Foundation -------------------- Prop. Line .........------.------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------_-------- --------------- Septic Tank (Specify Requirements) ---- -------------- -- ..---- -------------'-------. Disposal Field (Specify Requirements) __ ;d-------- ` ------------- -------- - ------ ---- - - -- ( ----- - - li::6- ---- - ---� ---------------------------- (Draw existin rid re )red dition 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 licen- sed agents signature certifies the following: "I certify that in the performance the work for which this permit is issued, I shall not employ any person in such manner as to bec a s*ect..taWma Compensat' aws of California." Signed -- ---------- - - ---------- -- --- -�-- ---- --- --------. Owner By ------ Title -------------------------------------------------------------------- -- (If other than owner) FOR DEPARTM NT USE ONLY qq APPLICATION ACCEPTED BY ------------ ---------------- - ----------. DATE ------ � bF --------------------- - ------------------------------------------------------- BUILDING PERMIT ISSUED --------------------------- ------ ----DATE -------------•-----------------•----- ----------------------- ADDITIONAL COMMENTS ------------------------------------ ----------------------------------- ----------------------- ------------ ------------------------------------------------------- P - _- - - -- -- - ------------------------------ ------- ---------------- ------------- ------- t ------------------------------ --------------------- �� - --------- - - --=------- Fina! Inspection b �r y Date ? ------ pY: ----------------------------- ------�i�-�`-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM