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FOR OFFICE USE: ------- ---------------------- -- ---------- - APPLICATION FOR SANITATION PERMIT 73 S� Permit No. -------------------� (Complete in Triplicate) 127 R -------------------------_--_-___-____ This Permif Expires 1 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: x - �-�� 2-SZ/- a�0- JOB ADDRESS/LOCATION......�_5----- lily__ k�,dw------ -- ---� P/CCS.---_--------CENSUS TRACT __.c ------------- .fC'f�jf 0--J.Al ZA-------------------------------- Owner's Name - -----------------Phone.-2 -1 39ja________-- Address --------23_C'�.1......a4mil l.,-,-6 = City /� ' J Contractor's Name i �__LLYu6 License # Phone Installation will serve: Residence XApartment House❑ Commercial ;❑Trailer Court ,❑ Motel ❑ Other -------- �� ••--�----------------------------------- Number of living units:-----.--_ Number of bedrooms _--ti.?_....Garbage Grinder _._ Lot Size - -------------- Q>> s Water Supply: Public System and name -----------------------------•------ -----------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ cs4 Hardpan E] Adobe '( Fill 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK,X Size----------"_0--------------------------- Liquid Depth ------- _.!__-__,_-_-- Capacity _/ __.___--_-_ Type _VZ4?j'j---- Material Z(aL-4-__ No. Compartments ____�___---_:__-- Dis#ance to nearest: Well _-a ________________________Foundation ------------ Prop. Line _-..- `_...`___._____ LEACHING LINE [ ] No. of Lines --------3------------- Length of each line_------ u-------.------ Total Length .__-____---__ 'D' Box .YR5----- Type Filter Material Q*_1,6-�--__--.Depth Filter Material ---------/_..------------------_________ Distance to nearest. Well 00)w-------------- Foundation _.�------------- Property Line ------a5-.--------- SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ......_-------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------.-----------------_) SepticTank (Specify Requirements) -----------------------------------------------------------------------------------------------•------------ ..--------------------------- DisposalField (Specify Requirements) ---------------------------•--------------------------------------------------------------------------------------------------------- ------------------------------- ------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ {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 ject to Workman's Compensation laws of California." Signed 1_.._ Owner ------------------------------------------- BY - ----------------- --------- --------------- Title ------------- - (if other than owner) - - FOR DEPAT#.; USE NL APPLICATION ACCEPTED BY --------------------------- ------ ---------- - --- --- --- -- = DATE 'F=��------------------ BUILDING PERMIT ISSUED °. 4.:' ------------- DATE ADDITIONAL-COMMENTS -------------------------------------- ------ --------- --------- ------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- -------------------------------------------'------------L-------------------------------------------------------- - -- --------------------------- --- --- ---------------- ------ Final Inspection by = s ------ ----------- Date -" SAN JOAQUIN ).CAL HEAL DISTRICT E. H. 9 1-'68 Rev. 5M G�