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FOR OFFICE USE: ILI f APPLICATION FOR SANITATION PERMIT �° ....�.......................................... ........ � ! Permit No. .--73•---• - --- ------------ ---------------- (Complete In Triplicate) l .......................................................... 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 Regulotions. JOB' ADDRESS/LOCATION .......--`: :...-W.. /SSN W .. CENSUS TRACT :.--•------•.............. Owner's Name ............. sr'..0 jL.S... . 1 ..... ---....... -------........-------------------Phone =.f. . a..._. Address - ,--------- ------- City Sd?�e Y �`r....................... Contractor's Name ... -.. -'.... / !$-.. a�+^s�---------------License # tt ..�� _J.. phone Installation will serve: Residence (XApartment House Commercial ❑Trailer Court ❑ Motel ❑Other :,............................. Number of living units:......I.._. Number of bedrooms .-----Garbage Grinder ............ Lot Size _.. .....:... ;k r Water Supply: Public System and name ..... .... ....... . •---•-•-..--- ------- ----- -----= ---------------------Private Character of soil to a depth of 3 feet: Sane!❑ � Silt❑ Clay ] Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 91 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.) t NEW INSTALLATION: (No septic tank or seepage pii permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK iSize........- :...... .............. ....: Liquid Depth .........................�.r Capacity .. ... .... ......ITYpe ........... ----- Material.----........ ........ No. Compartments ......................rr Distance to nearest:,Well . ......... .....................--Foundation ....................-. Prop. Line ...................... LEACHING LINE [ ] No. of Lines ..-. ..... Length of each line- _... ..- ..... ...... Total Length ......................... L� 'D' Box Type Filter Material ....................Depth Filter Material .... ...... .. C Distance to nearest: Well ............. �Foundation-"..................... Property Line ..---------_---_....-G SEEPAGE PIT f ] Depth r Diameter ................. Number Rock Filled Yes ❑ No - - Water Table Depth- ---------------------------------------------Rock Size ...................... F ' Distance to nearest: Well _..........---------`r=---:l.'---: ...____ Fovndation ........ Prop. Line ---------............. � REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date --------_.___------------.......) Q Septic Tank (SpecifyRequirements) .................................. --------- ........................... ............. Disp p Y q osal Field (S ecif Re uirements) ,......... --- • ....�G' -�r .........1..!!4�t,......:. C.`..................... ........ rr aC . ................................................. .... . .... ............ ------ ............. ..........................................------------------------- ------------ - ............... ------ ............................. (Drdw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the'work will be done in accordance with Son 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 su ject to Wo man's Compensation laws of California." '+ Signed .... .... .. -...y�-------- - - -------------------•----•. t --------�---�------------------- Owner 7� BY -r...... ..- _ / .. _ fix............... ......._.._... �............. 1-- --- ----- ----------------- -- ..._-. Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... .._e . _ .................. DATE .,.. �. ...�".... BUILDING PERMIT ISSUED .----•........ ................... ...... ---------------- ........... DATE .t- ---- ....................... ADDITIONAL COMMENTS ...... ............................•--------------......... .._........... -- ..... ------ - -_...__. _ ...........�_s. ........... ............................ :. ---....---------------------• - ......................... -... t f f Final Inspection b .. • r. _.. .. _ ..... p Y' ' ' SAN 'JOAQU LOCAL HEALTH DISTRICT s i �1 : H. 13 24-1-'68 Rev. 5M - -= - - 7 7,2_ .K <.. --