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FOR OFFICE USE- APPLICATION FOR _XANITATION PERMIT --�--- - -�----------=- (Complete in Triplicate) Permit Na. ------------------------------------- � � � -- 7 �-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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulatio s JOB ADDRESS/LOCATION ._. �_ /'-'�r�� n_-,, �_ � }} ` � ---------M TCS ---CENSUS TRACT --------- ---- Owner's Named-l?bc ------Z -tl-�c%/�� -----------------------------------= ------------------Phone •- ----------------- Address --�� - Ci tY I y �3 S ` Contractor's Name = - = License #� ��+� Phone ----- ---------- Installation will serve. Residence MIApartment House'[] Commercial :❑Trailer Court C] i Motel ❑ Other --------------------------------------- --- 407- OF Sic-COR b - Number of living units:--- !------- Number of bedrooms ______Garbage Grinder ------------- Lot Size ----75 ©---10--------- Water Q---- Water Supply: Public System and name -----------------------------------------------------------------------------------------------•---------------Private Character of soil to a depth of 3 feet: Sand'o Silt❑ ' Clay ❑ Peat❑ Sandy LoamER C lay Loam.0 r »... . ,T,. ._ . . Hardpan .Adobe Fill Material __ �__ If es,typ ____-__ (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 sewar is avai gble within 200 feet,) v PACKAGE TREATMENT { ] SEPTIC TANK ,�` [ ] Size_-_ r __ /-r- ---- -------- Liquid Depth . �--________---_-_ �I Capacity _�_vl ,-- TypeMaterial_ateo___________ No. Cmpartments _____________ ---- Distance to nearest: Well --------- --------------Fou-ndation ----/--a-/------ Prop. Line ----------------------- _ LEACHING LINE [ ] No. of Lines -.- ----/------------- Length of each line-? ______ _______ Total Length _______� '-. . E � D' Box __E_5__ Type Filter Materi I __ Q. _ Depth Filter Material ______ __- -- ______________ ti yI L-T-F Distance to nlares�: We -____ -- Foundation ----- Property Line, --- Depth __ ------ ---- Diameter S_ __�'Z_ Number _______I____________________ Rock Filled Yes �o i❑ Water Table Depth -- ---------------------------------------------Rock Size ---------------------------•---- Distance to nearest: Well -------------------------------------...Foundation -------------------- Prop. Line ----------------..._.. 1� REPAIR./ADDITION(Prev. Sanitation Permit# -•------------------------------------------ Date -------------------- -----) r � Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- --------------------------- Disposal Field (Specify Requirements) ---PK1F1-lr1N_C:.-:---A4S--------DR__A169�D-------=�y-----Fl.X E------------- C� ----- :iE_.X-I-5T)-N[6---------SEPTUC;� --------f 7}!�tK `C � [3 NhQN�b ------------------------ (Draw existing and required addition on reverse side) " I hereby certify.that I have prepaied this application and that the work will be done in accordance with San Joaquin County Ord'inan'ces, 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, l shall not employ any person in such manner as to become subject to Work 's Compensation laws of California." Signed _._ 1 - Owner BY ------- -- ------------------------ Title (If other than owner) ' i. FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED .BY DATE -----7_ �5_ BUILDING PERMIT ISSUED ! ------------ ---------------------`-----------------------=--------------DATE ------------- ----------------- i ADDITIONAL COMMENTS _._ •-------------•----------------------------------------------------------------------------- ---------------------- ----- ---- - - --------- ------------------------------------------------------- ----------------- ------ ---------------- ------------- 0 Final Inspection ------ - - ----_----------------------- --- -Date. -----_/_-7- - IR i I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 - 1-'68 Rev. 5M �I