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P � FC2R OFFICE USE: 1 i G APPLICATION FOR SANITATION .PERMIT ,t l ---------------------------------- Permit No. 73--/ (Complete in Triplicate) ----------I------------------- ----------------------- -- _----_- V This Permit 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: JOB ADDRESS/LOCATION J�,_ G,.�-cam Poe -��` ______ EISUS'TRACT ________- ------------ .Z� ^ iC Owner's Name - - -- - -------------- - --- ------------------------------------ _Phone 7r 4f 8' o� Address f 1� -------- ••-• City - - = Contractor's Name _----._ ___________ A: _ __-----License #AF-21-117-__- Phone 0_ r Installation will serve: Residence PeApartment House-E] Commercial [-]Trailer Court i❑ 1 Motel ❑Other -------------------------------------------- Number of living units:____ ____ Number of bedrooms --•-----Garbage Grinder -- __ Lot Size --- Water Supply: Public System and name ----- - --------411.a -`------------------------------------I ___Private ID------------------- Character of soil to a depth of 3 feet: Sand Silt F1Clay ❑ rl eat E] Sandy Loam .0 Clay Loam ❑ Hardpan ❑ 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'' Size_____ - _/0---e-------- Liquid Depth ---Is r N Capacity/.4eU-CAL Type .ru_ _ Material--- No. Compartments _Zr ____________ _ - Distance to nearest: Well -----a'�0----------------------Foundation .../0 -------- prop. Line -`a____r:________ LEACHING LINE f No. of Lines -----oz____________ -Lengtk' of each line.�_.F _--___._.-___ Total Length __.17 --- I ! 'D' Box ___/----- Type Filter Material _AP�tle-----Depth Filter Material -----/01-1------- Distance to nearest: Well --------- Foundation �Q -- --------------- Property line. --•-------- X9N0A"F:=T Depth __Aq---------- DiameterZ)e'ld______ Number __---------CP-----__--- Rock Filled Yes A No C Water Table Depth ---------.7u, --------------------------- Size -------.4-,rr--------------- Distance to nearest: Well ------- ___--------------------Fouridation _"lam__- __ Prop. Line ____4____.__._..__.. REPAIR/ADDITION(Prov. Sanitation Permit# -------- ------------------------------------ Date ----------------------------------I Septic Tank (Specify Requirements) ---------- ---------------------------------------------------------- ------------------ ------- - Disposal FiEld (Specify Requirements) ------------- - -------------------------------- ------------------- -------------- _ f --------------=-------------------------------------- -------------------------------------------------------------------------------- ------------------------------------------_---------------------- ----------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- JDraw 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 ----------------- -------------------------------------------- ---- Owner £ ------- --------- -- BY ------------- �'�' = Titie ----- ------------ --- --- -- -------------------------- (If other than owner) FOR ARTMENT VW ONLY APPLICATION ACCEPTED - -__-- ' --- - --------- fV- DATE --_! .--- -- ----------- -----. BUILDING PERMIT ISSUED ------------------ -____-_____. DATE*_ ------- --F--- - -- -------.- -- -------------=------------ ADDITIONAL COMMENTS _______.___________________ ' i + --------------------------------------------------------- ---------------------- ---------------------------- ' -- -------------------------. -- ---------•-- ---- --- ------------------------ Final Inspection b Date -_ _ - '--- -.-. p Y• -- � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M 4 � f ,