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FOR OFFICE USE: - APPLICATION FOR,-SANITATION PERMIT z --------- ------------ - ---------------------- Permit No: ----73_ ....... (Complete in Triplicate) ------------------�--_---. -- ---___---__---___- This Permit Expires 1 Year From Date Issued • Date Issued uin ocal Health District for per it..to construct and install the work herein Application is hereby made to th�Aaa'n Joaq described. This application is made in compliance with County .Ordinance R-6-549'*and existing Rules and Regulations: JOB ADDRESS/LOCATION -fc _1_ .......1 - -,SR _�q_ CL1, _=q__:_,_CE US TRACT Ap�'-sr Owner's Name ---- .. �. h ---------- ------------------------------------ -------------------Phone--------------------•-•----•---•---- Address ---- =�' { �'Yf------ ----------------- Y ---- ---------------------------------------------------•-•--•--- Name . - _---- ___-- - - _-- ____--.License # `�1- - -$----- Phone - --------------------- Contractor's f Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ------------- ------- ---- ----------------- : f Number of living units:------.__ Number of bedrooms --:Z------ Grinder -_ Lot Size ---------- Water Supply: Public System and name --------------------=--------------------------------- --- -------------------- -----------=------ --------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) quid D - �_____ �r4jrMatleriaLL-i,-�&- No. ' ____PACKAGE TREATMENT SEPTIC TANK:X _ � - L' mepth Capacity Type Cotments _____ _ Distance to nearest: Well ---- /r: _ _____-Foundation y---- ---___ Prop. Line ___S,._ --------- LEACHING ..._ ._LEACHING LINE of Lines ----- -------------- Length ofac.�_�__Depth hi line__ f.-_ _�-_ Total Length �__ ,�---------------- 'D' _----___-_.- -- 'D' Boxrto-nea -__ Type Filter Material Filter Material- ___40__________________/_.--_--_.-___:. ---- , rest:W I____ -�--------„Eoukdation .-��-r{_-__-____-_ Property Line. --------------------It— - ��____- Number _._ ____ ___________ Rock Filled Yes ©o ❑SEEPAGE Pl7 ['L}}�Depth c�.�___-______- Diameter ____ ff� � _ � Water Table Depth ---------- -�- ---------------•- �--------Rock Size ___-t.l-1__�_,.�------------ Distance to nearest: Well ----- ------------- ----------Foundation,:_ _ ------------ Prop. Line_.__.....___..__ REPAIR/ADDITION{Prev. Sanitation Permit# _____________________°-----------------_-_ -'Date ------------------------------------ Septic ________________.__:_______--____} Septic Tank (Specify Requirements) = =°•n "_---------------- ----------------------- --------------------------------- Disposal Field (Specify Requirements) ______________ __ ________s_;-_-r_— �^w- — �---- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) t 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, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agerits signature certifies the following: "I 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 to Workman's Compensation laws of California.” j Signed --------- { ----------------------------------- Owner �` BY -----------------•-------------- \- -------------------. Title 's".r` --- ------------------------ :(If other a owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- '�' --- ------ --- - 1-------------------mTE ��3 BUILDING PERMIT ISSUED ---_ ------------------ --iDATE ------------------ ADDITIONAL COMMENTS --------------- _. ----------------------------------------------------- - ----------------------------------------------t--------------------------- G s : :,e s: : ----- -----•----------------------------------------------------------------------------------i--------------------------------------- ----------------------------------- ----'t-}-'1----------=------- Final Inspection by: - -- -------- --- ------------------------------------------------ -. - ------------------------ kDate ----- - ��-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M `-AGO LJ