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FOP OFFICE USE: APPLICATION FOR SANITATION PERMIT ! 73 (Complete in=Triplicate) Permit No. ................ t p Date Issued - ...].. This Permit Expires 1 Year From 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 ,......D..d� ..,.. '... . .......... ._.4 .................. ........... CENSUS TRAGI ........--•-----....a:.... Owner's Name .......................... M.•----•-•--•- �`.............._........................., _....................Phone ................. • y�.; Address r City ................a. ... '� ....... s_... ---._...__...5.._3 3. .................. .....-•--..... Contractor's Name __..License # ___`�_...._. ..._ ..:_..----.�........... ...............•�`--�------•............�•---�.._ •------- Phone_.5-t.C�._�Wtk7.... Installation will serve: Residence JEfA partment-House o Commerclal❑Traller-C6urt Motel ❑Other - ---------- ; Number of living units:.....C '_5 ---- _-__... Number of bedrooms `_ --__-Garbage"Grinder ------------ Lot Size .. �. �_fi......................:.> Water Supply: Public System and name ---••----•-------------------•-•-•-- .------ ----------......._....---•-•. ------------------.-...Private [l} Character of soil to a depth of 3 feet: Sand .. Silt El Clay-C1 Peat'❑- 'Sandy Loam-❑ -'Clay Loam ❑ Hardpan ❑ Adobd%, Fill Mat"061 ...... ----- If yes, type ............................ + (Plot plan, showing size of lot, location ofsystem 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'[ ] ��` Sixe......k....•-••--___-_3 ......... Liquid liquid Depth .......................... Capacity -------------------- Type ................ Material...................... Nab Compartments ._.:................... Distance to nearest: Well ..........................k..........Foundation ....................... Prop, Line ...... LEACHING LINE j ] No, of Lines _______-_______________ Length of each Iine"`J................---------- Total Length .................;.......... D' Box Type Filter Material ....__....:=:.." :Depth Filter Material Distance to nearest: Well ........................ Foundation ------------------------ Property Line ___...... ............... SEEPAGE PIT [ ) Depth Diameter ................ Number .........._ ................ Rock Filled Yes ❑ No , Water Table Depth .............Rock Size t Distance to nearest: Well ....................----------..........Foundation .................... Prop. Line _._.................. REPAIR/ADDITION(Prev. Sanitation'Permit# -----------------------------------------... Date ..................................11 Septic Tank (Specify Requirements) ...................-•*..-...................................._ ................:............................. ..... Disposal Field {Specify Requirements) ....... Q. �-q .!_. .. vy, �........ ----------- ------------------------------------------••--------•--- .....---•--•--•----•-••....... (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 far 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 .. Title ...................:.... (If other than owner) V fOR A EPARTMENT;,.USE ONLY,, , APPLICATION ACCEPTED Y __:,.. ...... ........ ................................................................ DATE -_. 7_.� .:.'Z3. ........--_.._.. . BUILDING PERMIT ISS D ..._.... .. . _.....-•----......-•---•... ............... •---•••-- .--:.:..........:.DATE --•- ---- --•-• .... ............. ADDITIONAL COMM T ....... ..... ....... .• ........ - --------- ` - .?,- ...... .................. I...... ..... ---- ----- --- Fina Inspection by: ... ....Date . ....... .............. .••- SAN JOAQUIN LOCA(_` HEALTH DIS ICT , E. H.13 241_'68 Rev- 5M 7/77 3 M j