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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �7 Permit No. ..73- • __... ..............................I................. (Complete In Triplicate) 7-3 ............................... p Date Issued ...��' -3... .. This Permit Expires i Year From Date issued San Joaquin Local Health District for a permit to construct and install the work herein Application is hereby made to the described. This application is made in compliance with County-Ordinance No. 549 and existing Rules and Regulations: �1. �__ - Phone :,.... - ......CENSUS TRACT JOB ADDRESS/LQCATI N ._��•- .-• � _ ,,� .-.. ..-•------.�.. Owner's Name - �._.. .... m _ .. ....................... ( . : , Clty Address �� o ! �P ✓ ` 1.. .„: v - '.... .....: • 'Lice�tise'# Phone ....-. ......... Contractor's Name ..::. ” Installation will serve: Residence partment House❑ Commercidl {]Trailer Court °❑ Motel.0 Other ... ......... Number of living units•... Number of bedrooms � Garbage Grinder ..:........... , Lot Size W _ ater Supply: Public System and name:--_----_---.-•- """---__.. Private l Character of soil to a depth of 3 feet: Snnd❑ Silt❑ Clay Peat[] Sandy Loam ❑ ` Clay Loam ❑ _ r Hardpan ❑ Adobe.❑ Fill Material . If yes,type . Plgt Ian,, showing size of lot, location system'in .relation.-to wells,, buildings,..etc.,•must„be .placed'on_reverse side.( { ; p NEW INSTALLATION: iNo septic tank'or seepage pit permittedf public-,sewer'es available within 21. fee it e, ' h . ....._...•---•- Size _...- ........... ;Liquid Dept . .. J PACKAGE TREATMENT ( ] SEPTIC TANK[ j Material_._•-••_-.... No. Compartments ...•••- .. fCapacity -- ..... .. --- Type ....... ........ ,. -... : ; , ..� l Distance to nearest: Well ... Foundation......:......:.... Prop. Line .. :. .. ; of each line: Total,length ......----- ' LEACHING LINE [ ] No. of Lines __•--•-- length Q It ....... ... ... ................ D' Bak Type Filter Material” " ;'-:-•==• epth Fi er Materiel I Distance to'neo rest.'.,Well .......... Foundd#ion' Property -Line ••- [ .I : Depth _.::- Diameter ....... d No - Number• Rock Fills Yes CI,' C( SEEPAGE PIT :- Water Table -Depth ,.............:... ................... ........Rock . Distance to nearest.•Well . rop :. , , :.FOu'ndatlon, PLine _. 1 . REPAIR/ADDITION(Prev. Sanitation Permit#, .............................. .._-- Date---• ....... , ..... 5 Septic Tank (Specify Requirements)i P fY q 1 - ............. ,. W. - - Disposal Fi Id {SpecWye.cluirementsl l�- ..... � _ 0j ------ . -- ... ...---- ..."---- , Draw existiri and required dddition on -....---- -• ---------- ......................... ...._.- - l 5 reverse side) 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, ani# Rules and Regulations of the 'San'Joaquin Local 'Health District: Home owner.or licen sed agents signature certifies.the following: such monose .. "I certify that in the performance of the-work for which this permit is issued, I shall riot employ any penora in su I as to isecoM ! t to Workman's Compensation laws of California;" , Signed ... - Owner a ; .,.... B �.- J�` Title . . _.�®' '�L� c"� r :.. Y -• -- �/ - - s {If other than owner) _• - . . - H : FOR DEPARTMENT- USE ONLY. _ • I E APPLICATION ACCEPTED BY .. ED AT .. .........: BUILDING PERMIT ISSUED :_....:.::.. - -.; ' ....... ............. ...I._. k ADDITIONAL COMMENTS j ............. .... ... . -,...... .. •... ,, f .. .............. :.. :. `. .. z f Final Inspection by:` s . i " l 4� -SAN JOAQUIN LOCAL HEALTH DISTRICT. , -_w. � _„� �. .„n„ - - 7/72 3 M