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FOR OFFICE USE: �- ��(° APPLICATION FOR SANITATION PERMIT ----------- Permit No. 7_ 4 I� {Complete in Triplicate) -_ Date Issued ................... 73 ..._._..... ��•• This Permit Expires''I Year From Date Issued I Application is hereby macI4,to th 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: . 3� . .(. „ . ..... JOB ADDRESS/LOCATION _......... CENSUS TRACT .......... ... ... .. �} Q.... Owner's Name .................... I.. ... ---"- Phone ??-9...... Q ... .. ............... Address •---........ ........ City --- - - 7 .i _ Phone .......... Contractor's Name ' License # . ` " 6 �� • •••••- Installation will serve: i, ResidencelgApartment Housed Commerclal ❑Trailer Court 0 ;Motel ❑Other ._....rr.�.................•----.......-•---... t Number of living units:... M_ . Number of bedrooms ..v�._.._^Garbage_Grinder ._.. ... Lot Size ...................... .. .. Water Supply: Public System and name ....................................---......--•--------------......� rr..__-----------.Private ❑ Character of soil to a depth f 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam 0 ff, I, Hardpan ❑ Adobe'Q Fill Material ............. If yes, type ---------------------------- (Plot plan, showing size of�lot, location of system in relation to wells,_-bUildings, etc. must be placed an reverse side.) I NEW INSTALLATION:- INo:septic tank or seepage pit permitted if public sewer is available within 200 feet,) �r r i � ' PACKAGE TREATMENTII' SEPTIC TANK size...... __,!C__� .-----------•----------.- Liquid Depth 4F� �......... �+�t Capacity.. l Type ./ •_ Material.- e�— .�-�_No._Compartments i Disfance to nearest: Well ...----ZOO.._..'...__..____Foundation ..../0.. Prop. Line ...-�__'`._.... IIS .0 � I LEACHING LINE No� of Lines ........'.�/------ Length of each line------W-............... Total Length ..� �. __.._._.... -• 'D'�8ax YP Filter Material . I-e-•f.................. ...:... Type Filter Material . . Det Distance to nearest. Welir ----------- Foundation_..- --•_----_. Pro a Line _....... ...... SEEPAGE PIT` [ ) pth ......... Dia meter �{.`_�.�.. Nu er -- rRock, Filled Yes'{ . No (:] �tGtci�.t° Wafer Table Depth .. Rock-Size _f .-LlJ•- �., r i Distance to nearest: Well Z2. ..---__---:.,..Foundation __ Prop Line ....... -------------- REPAIR/ADDITION(Prev.'S'anitation Permit# ------------------------------ �fDate ..........:-_..................... ) Septic Tank ISpecify Regi•irements) ................ ............................. ........•-------------------........... ............ -•-•-..._-----.................. Disposal Field ISpecify'Requirements) ..............................................................-•----------...--------.._......----------------- .............. i i ........................ ...............................------- ------------....---•----•---...... Z_ 4..._... I` "-"----------------- ---------------- --•--- ---- ....._...---------.-.."--------.........---......---------------- -- ' IDraw existing and required addition on reverse side) I hereby certify that I hav4 prepared this application and that the work will be done in-accordance with San Joaquin County Ordinances, State Lows, 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 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 .... R "•----------•••--- __........ Owner By .._.....-- >� � =..._. Title ............. t ..._.... (if oth hang owned i t FOR DPP RTMENT USE ONLY APPLICATION ACCEPTED BY L ...... DATE ......... .. ........ j ADDITIONAL COMMENTS II _ BUILDING PERMIT ISSUED.:....... DATE .. .....................•-_.... ---------------------------"--------•---....:....- -------- ------------ - ------...... ------- ...........................--...................................... ............... .....:... ...................................... ........................................... ........ i Final Inspection by: ...:r.. f._.......... --"....................Date : .. --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 7/723M F_ H_13 24 t•'68 Rev. SAA