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FOR OFFICE USE: APPLICATION FOR SANITATION: PERMIT' ` Pe mit No:-:T 7 ............ ----------- (Comple a in Triplicate) ---------- -'�=S 3 Date Issued - 73 ------ ----- ----------- -- This Permit Expires 1 Year From Date Issued ------------- iall the work herein � Application is hereby mad t;the San Joaquin Local,Health District for a permit to construct and,inst described. This applicationis rriacle in compliance with County Ordinance No. 549 and existing Rules and Regulations: i ,� �/ r CENSUS TRACT -------•----- --;-------- JOB ADDRESS/LOCATION .-_ � = / 1�0-- --------- --------- ti s Owner's Name . . `-- ----�-- � _..Phone _�... ..,...._�- i Address - .� 1111 ------------`------------------- - - City____ I7-- ------------ License # -/�_7-�T3-- Phone 4;K� S�m?m - Contr actor's Name ---�/�- 5 � �'_// SE�� I Installation will serve: — Residence Apartment House❑ Commercial❑Trailer`;Court 1❑ Motel ❑Other -------------------------------------------- Number of living units:-.__ _-__ Number of bedrooms ____3------ Grinder V-P--- Lot Size _5 1.0 __/:� ----- Water Supply: Public System and name --------------------------------------------------------------- ----------••---------------------------------Private J? 1 Character of soil to a depth of 3 feet: Sand'❑ Silt{] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ I Hardpan ❑ Adobeg Fill Material ----- ------ If yes, type -------------- ------ (Plot plan, showing size of lot, location of system in relation t# wells, buildings, .etc, must be placed on reverse side.) W ' NEW INSTALLATION: (No septic tank or seepage pit permittediif public sewer is available within 200 feet,) 3 e P J PACKAGE TREATMENT { ] SEPTICTANK,� Liquid Depth -------------- Size-- ' l_ .?' �/-- --- ` 1�OIJ ! Type ,f 1MaterialG Y C% No• Compartments -------••--:=---- t Capacity YP t Distance�to nearest: Well --5' -r--------' Foundation __�6-------------- Prop. Line ---I-----_-------- fy k r LEACHING LINE [ ] No.'fof(Lines _ --------------- Length of each line____1M.____________ Total Length _1d0-•---•---- OG/� Depth Filter Material __I f_� ------------------------�---- 'D' Box }/�- -_ Type Filter Material / ______________ p } ' l Foundation f d=r .wP�operty`Line- �----------- Distance to nearest: Well ___V------------- --- SEEPAGE PIT � Depth ---o�_�.----_ -- Diameter ��-------_-: Num er ----- --------- ---------- Rock Filled Yes.© No i❑ ---------------- ------ /-Y--i--------- Water Table Depth __ � Rock Size __ # 1 Distance to nearest: Well -L�a--------------`--�---------Foundation /�------------- Prop. Line -.��----------¢------ = Date ---------------- ) REPAIR/ADDITION(Prev. Sanitation Permit# _------• ------------- - -- -� Sep#ic Tank (Specify Requirements) ------------- ----- - -------------------------•- Disposal Field (Specify Requirements) ----------- - _� .� -------------------- ------------------------------------------ ----------------------------------------------------------------- - . _ --------------------------- y 9 t t (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 liven. sed agents signature certifies the following: i "I certify that in the performance of the work for which this`permit is issued, I shall notemploy any person in such manner ' as to become subject to Workman's Compensation laws of California." ! Signed, ------ Owner f ----- -- ---------------------------- Title (if of er than ner) 1 DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- DATE __. - y�•-_7_3------------- APPLICATION PERMIT ISSUED ----- DAT - - --- - - --- --------- ADDITIONAL COMMENT. --------------------L------------ ---------------------- ------------- q__1= =��---------- �� ------------------------ -- -- ------- -- -- - ------ - - ------- --------------------`----------- `------- ---- --------------- ----- ------------------------------ - ----- - - - - ---- -------- ------------------ ----------- --- ------- -------------------------------------------r' - ----- '� a e Final Inspection b --------------- ----- N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Re - 5M