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'��{ FOR OFFICE USE: � i -7�/�,rnd , ra APPLICATION FOR SANITATION PERMIT r (Complete in Triplicate) Permit No. __73_--Sf/ ---------------------______._____.___________---______. This Permit Expires i 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 Regulations: JOB ADDRESS/LOCAA ON z pe.__�_1-A" -- - --------------- - - ---------- ----------------- ---- - ----------------CENSUS TRACT -------------------------- Owner's Name = 7 =- - --- --Phone ------ r Address ---- �1 22----- - ---------- City --------- ------------------- ------------------ -.- Contractor's Name ------- - -------------p _____ --------------------- --- .zLicense # _ _ Phone ---------------------------••- Installation will serve: Residence [Apartment HouseF Commercial ❑Trailer Court ;❑ Motel ❑Other Number of living units:-----/____ Number of bedrooms ---�----Garba_ge Grinder ----------._ Lot Size _ - ------_.- a Water Supply: Public System and name _______________________ -_--_-_--__.--_- ..Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam .0 Hardpan ❑ Adobe Lh, Fill Material ------------ If yes, type ___________________________ i (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,) p PACKAGE TREATMENT ( ] SEPTIC TANK' Size_J_ I6 x -� _-- Liquid Depth __�_ ------ 16 OL Capacity (_ '_- ---- -- Type __ Material__ - _ No. ,Compartments -------.�...... _ Distance to ne rest: Well _________ Foundation _..__.l ' ___ Prop. Line ------- LEACHING LINT; [ No, of Lines ------2o!Z------------ Length,of..each. line_=__._ _ _`Notal Length ___` �_ _. tl�f I` 'D' Box . � --- Type Filter Material ---- 5 5- -R___--_Deh Filter Material _____--_ '--- P ------/--------------------------- } Distance to nearest: Well ------- __ Foundation ------/_? Property Line _____n ...__. , SEEPAGE PIT [� Depth -----1--_51-1 Diameter _____ Number ----- Rock Filled YesA No .0 Water Table Depth ------------- � �� // Rock Size _'Y3 Distance to nearest: Well ______.._1�Q _________-Foundation __1� Prop. Line .............. REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- ----------------- Date _______________--_____________.__) k Septic Tank )Specify Requirements) -------- ----- E -------- -------------------------------- ' Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------•-------------- ------------------------------- ---------------------------------------------------------- 4 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 licen. } sed agents 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." Signed -------------------------------------- 7 = - Owner BY -------------------------------- ---------- t----------------- Title ( ` (If other than owner) 74-- FOR .DEPARTMENT USE ONLY y APPLICATION ACCEPTED BY - ----- .. -- --- ------------------ DATE -e---.. �-----`------ _7. BUILDING PERMIT ISSUED -------= ---DATE -- -- --- ---------------------------------- �. ADD TIONAL COMMENTS,,._ - -------- ---------------------- --- ---------!`fir ; ------------ - --- -- -- - ------ - ----------------------------------------------------------------------------------------------�-------------------- - Final Inspection by: ------- ---- ---- - -- --- --------•------------------------------------ --Date -------- -� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M