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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT '73—/0 Permit No. ..................... ................................. ........ (Complete in Triplicate) . ............ ....................---------------- This Permit Expires 1 Year From Date Issued Date Issued ..(i—�-•73 ......................................... Application is hereby inion is adein co plianLocal i h Cou©ytOrdinafor nce No, 544 and existing Rulesinstall nd Regulations- t4 egulat ons- rein described. This application s r vsa ��Q . O CENSUS TRACT .......................... JOB ADDRESS/LOCATION . ...-4-713 ..... ._ N3 r ....---•--......, .Phone .................................... Owner's Name -- Address .. - - --- --• - ----- � -----•.�.)06_..�-_°��--`- ' itY -- • •-• ._... ..t...................... ... .. ........................ .. ..._.. a. .. .. ; Contractor's Name .. ... ..I..Rlc�F.--- . ..............License # ` '3 .3. Phone . f -=' Q Installation will serve: Residence [&Apartment House❑ Commercial ❑Troller Court .❑ Motel ❑other . - - r Number of living units:.. ........ Number of bedrooms ..-3__.--Garbage Grinder ...__..... . Lot Size Private , Water Supply: Public System and name .................................... ....... Character of soil to a depth of 3 feet:._ Sand ❑ Silt ElClay {[ Peat C3 Sandy loam ❑ Clay Loam ❑ _ Hardpan ❑ Adobe E] 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 or seepage pit permitted if public sewer is available within 200 feet,) Li uid Depth ._. ............. PACKAGE TREATMENT [ ] SEPTIC TANK q P , ,c' Type _ �t�'-_......_. Material--- No. Compartments .._..._.. Capacity, �"R yp Distance to nearest: Well -..!`--------- Foundation ... .. .... Prop. Line --------------- --..__ Length of ach line �r �-............ No.' of:Lines . 'D' Box .._- Type Filter Material .. .---" ----Depth Filter Material ...f .......... ....... ........... r� d; __. .._ Foundation _1b�` .._...... Property line ........................ Distance to nearest: Well ..:-.._.. . SEEPAGE PIT ( j Depth �� ' __-... Diameter XA'-'% Number ....G"� -- -------../---- hock Filled Yes1d No Q "r -Rock Size ..... _% -- -------- �<<.,, Water Table Depth ----•----��.f---•------•------------------- � .._.... Pro Line ._, '............ Distance to nearest: Well .__...._I tva--' ---------------Foundation P• (� REPAIR/ADDITION.(Prev. Sanitation Permit# ----..-- •----• - --- ------ Date ---------------------------------- Septic Tank (Specify Requirements) ---- Disposal Field (Specify Requirements) ----------------- ----------------------- ------- ............. r -------------- {Drciw existing and required addition on reverse si d e) 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 licett. sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, i shall not employ any person lin such manner as to become subject;toorkman's Compensation laws of Cclifornia." Signed - . . Owner .� -- --....... --. - -- By . .: . . . .. _�......... Title .......---• ._. (if other than owner) FOR DEPARTMENT USE ONLY r ,�... . � �- APPLICATION ACCEPTED BY . . ...__._ . --- DATE . . . ......... ................. BUILDING PERMIT ISSUED . ...- - ---- .-- . .. ---. ..DAT ............... ..•----..._-•- ... ADDITIONAL COMMENTS ...... ._. -------- - ....----- .....- .-------- . ••------------- •------ __---_----- _-- ---....................Date r:' .......... Final Inspection by: ----------------------------•----- •----- -- -- SAN JOAQUIN LOCAL HEALT DISTRICT 7/723 .4 13 24 1--ma Pnv rm