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FOR OFFICErUSE: Y ` APPLICATION FOR-SANITATION PERMIT -- -------- 73 ----------------------- - -•-------- Permit No. -----------'---.. . {Complete in Triplicate) Permit -------- This Permit Expires 1 Year From Date issued Date Issued ___- _��_�� i Application is,hereby made to the San Joaquin Local Health District-for a permit to construct and install the work herein described. This pplicdfi_onds made in compliance with County Ordinance No. 549 and existing Rules and Regulations: i t/� - f d JOB ADDRESS/LOCATION�f 7�_ ......�__.__ _ 11!_____ I :---CENSUS TRACT __ ~ -----__-•__-- `ry- Owner's Name -----------P �jd.Q = Phone ` Address ----NI ------S-------- T City ` `-- Contractor's Name ------------ i r a --------------- License # Phone € Installation will serve: i Residenceartment House❑ Commercial ❑Trailer Court i❑ i � = Motel ❑ Other -------------------------------------------- nits ------ ------------------------ I .,Number of living units.__-_ _____ Nmber,of .bedrooms _2-,--:_Garbage Grinder j Lot Size - � __________ *,Water Supply: Public System and name;°�__-___- ------{------------- ---------------•--•--------------------- •---•- -- Private 'Character of soil to a depth of 3 fedi; i rt r p f°I la Son ad❑ Ado❑be.4Clay ater al Sal d yes, Clay Loam., -� �P ❑ f Y , type ---------------------------- ] N{.Plot plan, showing size ofnlot, location of system in elation to wells, buildings, etc. must be placed on reverse ..side.) EW INSTALLATION: }(No septic tank6or seepage pit ermitted if public sewer is av ilable within 200 feet? 4 PACKAGE TREATMENT I [ SEPTIC TANK [ j Size-------_----f________________________ _________ Liquid Depth __N,------------_._....... r-,�-�---�r�--- .-�^_4 €� Capacityrow- ----------- Type ----- -------------- Material----.-------- ----- No. Compartments k-------------------- Prop. Line ._`�..... Distance to nearest: Well ...!____Foundation --------------------- ..........- �rr ___ Total Len th �L�ACHING LINE [ J No. of Lines ------------------------ Length of each line---.--_-_-----____-- --_-- g ---•----•---•-------•_--- 'D' Box ------------ Type Filter Ma rerial ____________________Depth Filter Material ___________ } Distance to nearest: Well ________ _______________ Foundation ---------------------- Property Line ________________-_----__ SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number 1'!__.------------ ---------- Rock Filled Yes ❑ No I❑ ._ Water Table Depth -------- .Rock Size ---- - ------- --------- ---- -------- + " Distance to nearest: Well _______ _ __________________ _______ Foundation- _ ___-_____________ Prop. Line _.______.________..__. J.jREPAIR/ADDITION(Prev. Sanitation Permit# -------..------- -------------------1-- = f Dae -------------------- ,SepticTank (Specify Requirements) ------------------------------------------------ ) i _ ------- -------------A-------------- Disposal (Specify Requirements) --�� ! /.7f��--'�`r----- .. --------------- -------------------------------------:-- P ----------- `'/_77- - --------------------------------------------_------------------------ ___ - - - �^*— = "°` r _ --------------- =_----�-----------�-----------'-_ d C�.i (Dram✓*existin.g and required addition on reverse side) I hereby certi, that,,)-�hjdve prepared this application and that the work will be done in accordance with San Joaquin licenCounty-Ordinances ,$to `Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or -sed agents signature,c�rtifies the following: "I certify at in the perform a of th work for which this permit is issued, I shall not employ any person in such manner as to be , e subject,to Wor n's C pensation laws of California." 11 Signed -- - - - -- - -------------------- ------------- Owner �R,D----------- Title ------------------------------------------------------------------------ (If other than owner) FOR-DEPARTMENT-USE.ONLY f APPLICATION ACCEPTED BY _-----7( ``} ;' ` :y ''-'. DATE l { BUILDING,-PERMIT ISSUED--------------- -------------- - ---DATE.--------------------------------------- ADDITIONALCOMMENTS --------- -- -- -------------------------------------------------------------------------------•---------------- 41 ------- --------------------- -- --------- ----------------------------- - ---- -- ---------------------------------------------------------- ---------------------------------- .. -- - ------------------------- ----------------------------------------- -------- ----- -- - ----- -- - Fina - ---- ---------- --- --- --- ------ - ------ :----- --------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M x-