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y FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` 3 ----------- Permit No: ._73-/� (Complete in Triplicate) - ---- ------------------------------------ �,_ �� ----�----------_--- This Permit Expires ] Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 ---------140,?,V_-_-3-------> -.--- 5.--"-- /06,4'7_Cr_� .CENSUS TRACT --------------•----------- Owner's Name -- -�-------Isue --------------------------------------------------------------------Phone Address ---- - 0-3- f DW-yes- ----------------------------- City ----------------------------------- ------- Contractor's Name __� ..1 � �-- � ------------------License #� �7��, Phonec' . Installation will serve: Residence KApartment House-[] Commercial❑Trailer Court i❑ Motel ❑ Other ---------------------- --------------------- Number of living units:--- ----- Number of bedrooms .___Garbage Grinder ------------ Lot Size ...., �_-',?C_-e-�------------ Water Supply: Public System and name -------C44 . X2.1--------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat❑ 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.) O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ]""'` R Size-------------------------------- ------ Liquid Depth P;/l Capacity `T' e -------------------- Material--------- ----------- No. Compartments ------._.....------- Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line ------------- ..______ LEACHING LINE No. of Lines __,___ f [ ] �-------------- Length of each line----_.��------- Tota! Length .----��--•---......-- A,� i er fr (.$�� 'D' Box _`.cdr�_-Type Filter Material ��- ---Depth Filter Material ____��_-------__________ Distance to nearest: Well ___ ,_ Foundation ___. ______ Property Line. .............:.. g- ft SEEPAGE PIT [ ] Depth ___ �7 Diameter _ ___ Number ----------�_______ ___�Roc il�ed Yes o Water Table Depth ------ -----------------------------Rock Size , _---_- r� Distance to nearest: Well �_ __�_______________Foundation ___la________ Prop. Line _._.1sS___-__••.__.__ REPAIR/ADDITION(Prev. Sanitation Permit# ____------------------------------------ Date --_________________----___-_-____] SepticTank (Specify Requirements) -------- --------------------------------------------------- --------------------- ------------ ------------------ ------------------•--•- Dis osal Field (Specify Requirements) __ 1______s ____ __ -�-��- i �. -- ------- --- --� ---- ----- --- ------ (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 beco blect hWork is C pensation laws of California." Signed _ ------ Owner r BY ------------------------ --- --- -C� ----- Title - =>- ------------- (If of er th owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ -------------------- DATE -_------------- APPLICATION --- 3� ��-------------_-- -- -- ----- ------ ----------------------------------------------- BUILDING PERMIT ISSUED .--- DATE --------------------- ADDITIONALCOMMENTS ---------------------------------------------------------- --------------------------- -------------------------------------------- -------- ------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- 1 - ------------------ Final Inspection by: r� ------------------------ --- --- ---- -----------------------------------------------Date V SAN JOAQUIN LOCAL HEALTH DISTRICT C o E. H. 9 1-'6$ Rev. 5M '_,