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rf FOR OFFICE USE: APPLICATION FOR SAN!TATION PERMIT• Y -------------------------=------------------------ Permit No: 73 EComp!teyn'Tri plicate) --------------------------------------------------------- e --------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the an 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 Regulations: ' JOB ADDRESS/LOCATION //� �__ , ._�� _______________ ----- ------------------CENSUS TRACT -------------------------- � _�_9 7Owner's Name -----:� h__---------- ----- ---------------------Phone ------------------- Address --- --------- rl Address --------------------=-- f ;` City --4 --Name ---��w� '`'-------- --------------------License # ------ -------------- Phone ---------- ------------------- Installation will serve: Residence 0 Apartment House,❑ Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:---/-------- Number of bedrooms ---- -__-Garbage Grinder ------------ Lot Size lam'' ___._ _ _.___�__/._.... Water Supply: Public System and name - -------------------------------•--------------------------------•-------------------------------------------- rivate Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan ® Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (PI'ot 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,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size______________________________________________ Liquid Depth ._-_______.___----__,_-_- O Capacity - ----- ---------- Type -------------------- Material---------------------- No. Compartments ------•---- •-•-----• 041 Distance to nearest: Well _______________________-___-_-___Foundation ---------------------- Prop. Line .............:........ e LEACHING LINE [ ] No. of4 Lines _______________________ Length of each line-----------------.---------- Total Length _____--__-____-_____________ `D' Box ------"I,--- Type Filter Material --------------------Depth Filter Material ------------------------------.--_---------- 1 r F Distance to nearest: Well ________________________ Foundation - ---------- Property line -_________________._____ k SEEPAGE PIT [ ] Depth -------------------- Diameter ______________"I_ Number --------------- ------------ Rock Filled Yes ❑ No C 4 Water Table Depth ---------------------------------�-=-- ``--=----Rock Size -------------------------------- --� ------�---- I.--...Foundation -------------------- Prop. Line -------------- Distance to nearest: Well _____________ ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# _ ____________________ ) --------------------- Date ---------------------------------- Septic Tank (Specify Requirements) _._ --�- -'� ------1:-________ c------------------------ �----------- -------- -------- ---------o---- ,+ =�-Disposal Field -(Specify Requirements)'-------�% �� = 'c % �''`� g ' � � r.rU ---------••-- -- - _ .. - -------------------------------------------- --------------------------------------------------------------- ------- ------------------------------------------------------------------------------------- (Draw existing and required raddition 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, I shalt not employ any person in such manner as to become subject too.Workman's compensation laws of California." Signed _d17 ': ✓----- Owner BY -`�---- ------------- Title ------------ --- ---------------------------- --- --------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------y Z�-------------------------------------------------------------- DATE '' T ---------------- BUILDING PE=RMIT ISSUED --------------------- - ----------------------------------DATE -------------•---------------------------- ADDITIONAL COMMENTS --------.--------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- --- - - -- ---- ----- Final ---Final Inspection by: Date _l_ " -- _:. SAN JOAQUIN LOCAL HEALTH DISTRICT VIV E. H. 9 1-'68 Rev. 5M