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FOR OFFICE USE: APPLICATION FOR, SANITATION PERMIT 73 —ld3 v ------- -- --- - ----------•------- (Complete in Triplicate) Permit No- -- ------------ ----- ________________________________________ Date Issued--_-__________._ This Permit Expires 1,Year From Date Issued i 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 Counfty2 OrdinAan�ce No. 549 and existing Rules and Regulations: - ._--`--1_ JOB ADDRESS/LOCATION _ 1_�5 __ _ _--, -!- -„ - CENSUS TRACT Owner's Name ------ , - it I]! ----------------Phone ---- ------------. Address - . 5 ----------6a ---------------------} .. City ---- c L -----------------------._.._.......... n Contractor's Name -------- -- W//_EF__1_ -----------�---- ------------------------------License # -----\------------------ Phone ------------------------------ Installation will serve: Residence partment House�❑ Commercial ❑Trailer Court ❑ l� ' ; ;NumMotel ❑Other ------------------------------ Number ber of livingunits __._. E __._ Number of bedrooms Garba e GrindeY " � _ - / 5 Lot Size I Wiz-. -- ----------ti-----•---------.,"------- Water Supply; Public System and name _________________________________________________ ___________.___.Private Character of soil to a depth'of 3 feet: Sand Silt 1:1 Clay ElV Peat ❑/ Sandy Loam❑ Clay Loam E] Hardpan ❑ Adobe '0 Fill Material !-I/_'. -.k If yes, type`r___________________________ (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 seepa it permittedifpublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ 5-6 Size_l__ ___'#- �____�I&A_t________ Liquid Depth -_ _ ____yy_��_________ Capacity .� Q _f_ Type [ " T_ Material P1�_'B 1____ No. Compartments 1�d nQ istance to nearest: Well _._._____ 'j~________Foi�,ndation ---1�--_- --____ Prop. Line ____ LEACHING LINE [ No. of Line's _____________'_-••Length ofppeach line -_ Total Length__..-__..__..._____. D' Box lT .De th Filter Material Type Filter Matenah,=_. 4 �r YP a,, .�. i r_------ -•--------• f `� ,-------- ation ,__ Property Line - ��---•-- ........ Distance to nearest: Well -- -- --�'-�— F SEEPAGE PIT [ ] Depth ---------__-__---_ Diameter Number __ `_ -_ _____________ Rock Filled Yes ❑ No [f Water Table Depth :._.Rock Size _1'___________________________ I i, Distance to nearest: Well ---------------f----------._..._.-_ ...Foundation---------------------. Prop. Line -------------_-------- REPAIR/ADDITION(Prev. _-___•-REPAIR/ADDITION(Prev. Sanitation Permit# -------_---_ -----------_____________„?-_--,_ Date ___)-____ _______________._ }_I �{ ! Septic Tank {Specify Requi`reirents}' -------------------° ------------------- ------• ------------------------ a tp Disposal Field (Specify Requirements) ----------- --- - - ---- t�, -------'- ------------------- -------------------•--------------- - a--- -- Draw existing and re ( 9 q.d--------------------- -----------------------------------------------I----------------- t ' aired addition on reverse side) 1 I hereby certify that I have prepared this application and: that the work will.-be done in accordance with Sari Joaquin County Ordinances, State Laws, and Rules and Regulation's of the°SaniJoaquin,Local Health District. Home owner`. or [icon- sed agents signot a certifies th ollowing: :g 3 "I certify th t in e p man } of he work for which this permit is issued, I shall Snot employ any person int such manner as to be e s ject ti rk n” ompensati.on laws of''Colifornia."'I .c Signed t- ------ ------- r:. ------------------------------ - wfeC -------'Y----------------------------------------- r P -- --- Title. ------- - - '---=�;- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ---------------------------------------------- -Lf-:. ------- BUILDING PERMIT ISSUED ------------------------------ ------------_---- -------DATE -- ---- ------ ADDITIONAL COMMENTS - --- -- ---- ------------------------------------- ...,•... - --�--------------------- -- ---- ---- �----------- --- ------ - - - - . — --------- --- - —- - Final.los ,echo Dat ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,