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lFOR OFFICE USE: APPLICATION FOR SANITATION PERMIT '..-......_. d ............. (1 .... Permit No. ... 7:...-70� / {Complete in Triplicate} Date Issued ....Y-:f d=7=3 ............ ...... ....... . This Permit Expires 1 Year From Date(slued 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- TI .... JOB ADDRESS/LOCAON ..._... ....... ...............................CENSUS TRACT ......._.......--•---- - vim.VsJ ... one Sv .......l ., .. ........Owner's Name .... Address . -.-.-----ash —:.....(`... -.. ------..... City _._ ..................... ....... Contractor's Name .. r.__ -5 `` •.. License # S 3Y` ....... Phone .". Gf:( i O...... Installation will serve: —-—Residence [kAportment House] Comm ercial-07'raller Court-0-�-- Motel ❑Other ----_---------------- Number ---_---------------Number of living -units:____.:..-,Number-of,.bedrooms.,:-.�---Garbage.Grinder ..=. .................................... Water Supply: Public System and name I-------... _0.a------------------------------------------- f--••--......................Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt[IClay ❑ Peat 0 Sandy lalam 0 Cloy Loam ❑ Hardpan ❑ Adobe.P Fill Material ............ If yes,type ----------------------------- n r IPiot plan, snowing size of lot, locatio .of. system in relation to wells, buildings, etc. rust be .placed on reverse side.) NEW INSTALLATION: (No septic tank for seepage it permitted if public sewer is available within 200 feet,) } PACKAGE TREATMENT [ ] SEPTIC TANK i ] Size------- `.. ... Liquid Depth ......-•----. --...... ... .................... t Capacity ._..------ ...... Type Material---- .�.......... No. Compartments ...................... � .......Foundation -•• Prop. Line lDistance to nearest: Well ............................ -•------..:...----- ...................... LEACHING LINE [ 7 No. of Lines --- --------- --------- Length of ouch line-----r----. ............ _. Total Length YP i l - r D' Box .....-___-- Type Filter Material` Foundation Depth Filter Material ........................................:... _ -�. .... Property Line Distance to nearest:' Well ._.�... ....�-------------• ........................ SEEPAGE PIT [ Depth ------------- ---- biometer ----..-.:..-.-.. Number ..:;..._.. ..._........I.... Rock Filled Yes ❑. No [ i Water Table Depth ----------..!------------ --•--..:..... .....Rock Size ..... -•••--........••---- I ' F I Distance to nearest: Well Foundation Prop. Line ....:.......... --•••-. ....... 1 REPAIR/ADDITION(Prev. Sanitation,Permit' #`) _.. Date,..__......................... - Septic Tank (Specify Requiremeritsl _w_ .... �..i►Jsa.. Disposal Field (Specify Requirements) = ----------------------*. -------- , I --------------- ,_..._..__.... ......... __......... (Draw existing onc�-e,equired addition on reverse-side) i .._....�., . 1 hereby certify that I have prepared this applrcat ^and'#hat the work'willJbe done .in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loccl'Health District. Homeowner or licen- sed agents signature certifies the following: j "i certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to becom bjec AWkmajns, Compen tion laws of California." Signed . --- •. ...................•-----BY ---------------------------•-- A. .-- ...... ..................... 7itle .._...._..............................----------------.................. (if other than owner} FO PARTMENT USE ONLY APPLICATION ACCEPTED BY ... :.. ... .. ..................... ....... ..... DATE ---- ' BUILDING PERMIT ISSUED ... _ .' ...... -- -- .. ........ •..........---------------------------.................DATE... ....... ADDTIONAL CO ENTS ............... .....................................-•••.-•---- ............................... ._ �:....................: :::::::::::::::::::::::-----............................................--......-::: ................ ......................•--...._..:::.:•. . ... . ....._ • = �^-----....---------•-•..._.. -- -------- ....... _ Final Inspection by: ... . ... _.. I.........._.............................................. ate .... �._ )SAN .J AQUIN LOCAL HEALTH DISTRICT C 1-3 24 7/72 3 H