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r FOR OFFICE USE. APPLICATION-FOR-SANITATIlON -PERMIT - - z ---- ----------------- Permit No. ._73_ Q (Complete in Triplicate) ----------'-------------------------------------------- - a ______ 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: JOS ADDRESS/LOCATION . -------5 vU-----9 ----� !4."--...... �K�/--�2 - --.--CENSUS TRACT -------------------------- Owner's Name -----------------j1ex=c_5AL--------&4t /Oa_t_�-----------------------_. --------------------------------------------- -------------------Phone ------- -------------------•---•-•-- Address ------------ -1-0------t�---- !` - -----------. City --------�t"a G----------------------------------------------------- Contractor's Name ---------- lk_!'I -----------------------------------------License # _P Phone 3 ` ....... Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other -------------------------------------------- _ Number of living units:_____---- Number of bedrooms -----L-___Garbage Grinder _1Vt?_... Lot Size ---/V/_tt 0____________ __ Water Supply: Public System and name ------------------------------------------------------------------------------------------------------------- Private Character of soil to a depth of 3 feet: Sand []' Silt❑ Clay ❑ Peat El Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ___________ If yes,type ---------------------------- Mot ______________________ __{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 T[4— Size-----------e57-15 f_9----------------- Liquid Depth ----1______________..___. Capacity ------ Type Material------C.0*10L,_ No. Compartments ----�._._.____-- t r f G Distance to nearest: Well ----------.'1_.U__-----------------Foundation ___-___.. ------ Prop. Line -----/LQ____________ LEACHING LINE [ ] No. of Lines ---------------f__------ Length of each line.--------------------------- Total Length ---------------------------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ________________-__________--___-._-_.-- Distance to nearest: Well ______________________ Foundation ------------------------ Property Line ---------------_------ SEEPAGE _____-._...___._ --..._SEEPAGE PIT [ ] Depth --------------------- Diameter _______________ Number __.-___-.- ----------------- Rock Filled Yes ❑ No 00 Water Table Depth ------------------------------------------------Rock Size -------------------------------- F Distance to nearest: Well ---------------------------------------Foundation __________________ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# _________________________________________ Date ------.---------------------------) 3 SepticTank (Specify Requirements) -------- ------ ---------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) __________________________________________-___-_-_ --------------------------------------------------------------------- - -----------V --------------------------------------------------------------- --1 - It ------------------------------------------------ --------- (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-y sed agents signature certifies the following: - "I certify that in the perf rmance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject man ompensation laws of California. SignedA- r Owner BY ----- ---- _ Title �. (If other than owner) .: FOR DEPARTMFN7 USI.,ONLY APPLICATIONACCEPTED BY ---------------------------------------s--.------------------------------------------------------- DATE ------------------------------------------- BUILDINGPERMIT ISSUED ---------------------------------[--------- -- ------------------------------------------------------------DATE -------- ---------------------------------- ADDITIONALCOMMENTS ------- --- - ---------------- -------------=-------------------�------------ - - `---------�------- ---------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - - ------------------------- ------------------------ -------------------------- -------------------------------------------------------------------- ---------------------------------- Final Inspection by- ------------------------------------------- ---------------------------- -- ---- -------------Date77-------------------- SAN JOAQUIN—LOCAL_ E H_DISTPICT,,._. .�_.��._ , E. H. 9 1-'68 Rev. 5M �,