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FOR OFFICE VSE: Permit 73Z --,APPLICATION,FOR. SANITATION PERMIT .....................�..... ...................... 1: t Na. ..7. :........... (C_ompieto in Tripilcate) P i f ... This Permit Expires 1 Year Froni Data Issued �� Issued ................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein E described. This application Is made In compliance with County Ordinan a No. 549 and existing Rules and Regulations, JOBADDRESS/L TI N .. /....3I� --------- -----•--•----......... .............................-----..................................CENSUS TRACT ..----.................... Owner's Name p. . . ./................�...---....... ............... ... . Phone .............. F ............. f xkddress . ............-.... �.. ... .f3 �a�.i..... .............. ..City .. Contractor's Name. . ...................................... :License # .715. 1.. Phone �?• �?- installation will serve: Residence EfApartment House❑ Commercial❑7raller Court ❑ : Motel ❑Other Number of living units:..../._.... Number of bedrooms ...s9..Garbage Grinder ............ Lot Size ......... Water Supply: Public System and name ................................................... ..__..........w.......................................... Prhrafs�` Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ - Peat❑ Sandy Loam❑ Clay Loom Hardpan❑ Adobe❑ Fill Material ... .......If yes,type ........................... AIN\ +Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse slde.lQ NEW INSTALLATION: (No septic tank or seepage pit permitted if publlt sewer is available within 200 feet Y ,) PACKAGE TREATMENT ( ] SEPTIC TANK f4 .... .. ......... .... 1�� .:�........... Liquid Depth ....................... capacity,��i�.�..--•.-_-- Type ke&7` _- Material _ No. Compartments ...cry............. ....Faundatiors Distance to nearest: Well ...f,�-•............... ..,C�....._--�:- Prop. Line, .2---- . ...... LEACHINGLINE [110""No. of Lines ......../............ Length of each line....: .. ........... Total Length ...�r�................ ....... D Sox ............ Type Filter Material -i.Rlepth Filter Material .......... ......... rN, r / Distance to nearest: Well .../4::53D.! :.. Foundation ...!� .......... Property Lina r/ SEEPAGE PIT ( Depth ..oq S......... Diameter ... Number ......./.........r...... Roc Illed Yes W No I Water Table Depth .. ,�...............•--........Rock Size .� .... r • r .... Pro Line Distance to nearest: Well .... Foundation ..,1/_.!�-... I ItEPAIRx ADDITIONSanitation Permit ••••) - ! (Prev.( ••�---_-�-----..._....................... Date ..F.......N................. :peptic Tank (Specify Requirements) ......................................... .-•--•-•...........---........ ........-- - _ ............. :._.................� Disnosal'Fielci (Specify Requirements) ------------------------------------------------------------ ................................................... .................. 5 . ..................................................................................................................................................................................................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dorsa In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horse owner or lican- 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 becomeAvbIlert to Wo an' Compensation laws of California" :geed �� .. ... ... .. ..../�.. .�.........ji�* .._ Owner By ..... ...................... (. 4-C1 _ 3itie .....^!�/ ..............---...... pf athe than owner) R DEPARTMENT US& ONLY APPLICATION ACCEPTED 11 DATE .... BUILDING PERMIT ISSUED DATE............................................. rADDITIONAL COMMENTS .... . -------- ---------------------------------- ......................................_.. ....I................. .............. F .............................. .................................................................................................... ............................•-.....----.---...----------........----.. . . .... t ..... .....- Date . ..--..... ...Final Inspection by:Ei 13 24 1-68 Rov. Sof SOqIN LOCAL HEALTH DISTRICT $!7(7 3M