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a FOR OFFICE USE: FO APPLICATION FOR SANITATION PERMIT -.--�- . -- ------ Permit . -_ _..c,., . -�..�— .-(Complete•in-Triplicate)- ----------I---------------------------------------- 73 --------------- 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 ' � --Cr--------------------------------------- CENSUS TRACT Owner's Name .... yam'.-------- ---- Phone Cit Address ---------�-��---- - f�f - ---�n�--=---------------- ------------- 4Prte' -�--/ Contractor's Name _ __.C. - !_ icense # 7 '1--- Phone - Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court :0 Motel ❑Other -------------------------------------------- // Number of living units:__-_ ____ Number of bedrooms ____...Garbage Grinder --------___ Lot Size ------4_Q---1- _/670..1 Water Supply: Public System and name ----------------------._______________ -- � -- Private E]- -------------------------------------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ 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 oY:seepage pit permitted if public,sewer is available within 200 feet,), PACKAGE TREATMENT [ SEPTIC TANK[ l ' Size}-____________________________- ---------- Liquid Depth --------.----------------- Capacity ---___-___ _Capacity ------ ---- -------- Type ------------=------ Material--------------- .-No. Compartments -------- ......... V— Distance to nearest: Well! ---------------------------------F undation ---------------- Prop. Line -------- .............. r LEACHING LINE [A No. of Lines --------_! �_____ Length of each line-----------44e__"'_----- Total Length A D' Box _._ Type Filter; Material ------ ---- Filter Material ___ Q --------------- ..... Distance to nearest: Well ------ Foundation�--- ----. ---- '_ Property Line _.:.... t �� :k . SEEPAGE PIT Depth --------��-__ Mameter"__4 Number __________ . Rock Filled Yes ® No C -- -- - Water Table Depth ' s' Y: ------------------ --..Rock Size ------- ---------- Distance •--`--- Distance to nearest: Well -- __J____________________ Foundation -____./ _______ Prop. Line- _____�_..'........_ REPAIR DITION Dev. Sanitation Permit# _._. --------1------------------------ ---- Date --------,----------------1:-------1 Septic Tank (Specify Requirements) <------------ ----------------------------------------------------------------- = ---------------- ---„.--- ---------•---------- Disposal Field {Specify_Requirements) ------------ t ___ 4;Q1.-r - --_------ .. qq ---------------=------ -------------- -- E' - ------ ------------- --- --------------------------- -*--------------------------------------;------------------------------------------------------------------------------------------------:------- (Draw existing and requirid addition on reverse side) F 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 t"-,San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 'Tcertify 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 -.- ----------- --------�° _----_>___,-� ,w._. _�_= Owner 6 BY , ------------- Title ` ------------------- (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------- -------------- ----- -------, DATE --- " BUILDING PERMIT ISSUED ---- ---------------------------------------------------- - --------------DATE ---------------------- ------------------- -- --------------- ADDITIONAL COMMENTS , --1------I ----------------------------------------------- -------------- --------------------------------------------------------------- ` -- ----------s------------------------ 1 ------------------------------------------- --- ------------ -- - ----- --------------------- Final Inspection by: a - -----�- ------------- -- ate - =-� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,,