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FOR OFFICE~ USE: APPLICATION FOR SANITATION PERMIT 73�t3S • Permit No. . (Complete in Triplicate) .... Date Issued A- 7 .............. ....„_,............ •-,.- This Permit Expires 1 Year From bate 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 Ordinan-ce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI �...... ._.. ....... f---- ---------- _._....._........CENSUS TRACT .:....:......_..._...:..:. Owner's Name ._.. - hone Address ._. "+ .. _ . ._.. �. .. "•--•.......---•••---•- City -- Contractor's Name ....- .... License # _--_---------------- Phone ..::--••-••... ............... Installation will serve: _ +Residence ❑Apartment House 0 C mmercial Trailer Court 0 Motel ❑Ofiher Number of living units:.__-_i_----- Number of bedrooms .__11 .':Garbage Grinder ............ Lot Size ------- Water .__-_Water Supply: Public System and name ----------- --•---..:.:...V'-: ='= y :_....------......................................_..............Private Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan ❑ Adobe VFill 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.) pp�� NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is available within 200 feet,) !' PACKAGE TREATMENT [ SEPTIC TANK Size....................._________________ --------- Liquid Depth .......................... � e ! . Material._ . No. Compartments ..+�..:. Capacity ! {TYIJe � �j�� ` P / . Distance to nearest: Well _.__.. ...............Foundation ...._ •T•-•'-•-.__. Prop. line LEACHING LINE No. of Lines -----------22< ..... Length of each line..___....__ ' Total Length 'D' Box . Type Filter MateriogW_ ZA .Depth Filter ffiaterial Distance to nearest: Well ._..1-U f=oundation ..._-1 _ ...._._... Property Line �� ......... SEEPAGE PIT [ 7 Depth Diameter ................ Number ------...................... Rock Filled Yes ❑ No ❑ Water Table Depth ..Rock Size 1 Distance to nearest: Well .......................................Foundation ........ ----------- Prop. Line ....................... 4 ,_..; Date ..-•----......_.....----•.---••---REPAIR/ADDITIONIPrev. Sanitation Permit# F._._. ---------------------------- 5ePtic Tank,(SPecifY Requirements) ....... .......... ---•--....1. .................... .......... .._..._.....-.-.-.•.• . � . �� };.......c�fy Requirements) •--••-Disposal Field I5pe . I f.' ....................................... ....... ................. .............................. ____________ ....... -----------------------------_.........._------------------------------- _ _ {Draw existing and required addition on reverse side} 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 agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued,-1 shaii not employ any person In such manner as to becomejsuec, o Work an`s Compensation laws of California.'Signed :- ........ ... ---•-•.--- i .., ., - _- --- .. Owner By .................. 3itle ................ ...... --------- ( f other than owner) 1{�l FOR DEPARTMENT USE ONLY., APPLICATION ACCEPTED BY - :...:. DATE ....� .I3:._ t ............. BUILDING PERMIT ISSUED DATE .............. -. •-•---..................... ... ADDITIONAL COMMENTS '' .............................. ...•.................. ...... ................................. ................................ ... ...........--------------------------—........... ........ .• . ._.........:_ ....:........................ . • •--- ••- Final Inspection by: Date � ... -- -• SAN JOAQUIN LOCAL HEALTH DISTRICT 1 c u 13 24 1_'AQ oe.. +cam 7172 3 M