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FOR OFFICE USE: APPLICATIONFOR SANITATION PERMIT ---------------- -------------------------------------- (Complete in Triplicate) Permit No: -.73-11-3-f --------------------=--------- ---------- -_--- -____-: ----This-Permit Date Issued -Expires 1 Year from Date-Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appli5ation is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: . I y JOB ADDRESS/LOCATION -----------16- - w_-----1!t/_y_� �y�.e_oLc-G>w,-- _CENSUS TRACT -------------------------- r-` Owner's Name ; A�_------------------------------------------------------ � Phone Address ------------ - �' f - ---------. Cit ,<'------- c- ----- Contractor's Narrie /7``.. �. C k_�-1 �:'------------ ------------ --------License # ---------:-------------- Phone Installation will serve Residence [:Apartment House❑ Commercial❑Trailer Court Motel ❑Other - !. f r Number of living units:.... - -- Number of bedrooms ___ __._Garbage Grinder .--------- Lot Size -- X71 ff f yUU_--- WaterSupply: PubliclSystem and name-_�ti_________f_--"._- ______._ _--Private i ----- Character of soil to a depth of 3 feet:- Sand Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam :❑ 9 •� ! Hardpan ❑ Adobe ❑ Fill Material ------------- If yr s, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse 'side.) NEW INSTALLATION:I (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK• Size____ y�s_-1.-7_------ ---------- Liquid Depth -- -d__-r,__._---.__. Capacity __1A--'1_U------ Type% ' _ p3J(_ Material----L_P.v.Ae, No. Compartments Distance to nearest: Well __------------- !_---_______Foundatio� ld- Prop. Line ----/_0.�f_____ 0 LEACHING LINEXi! No. of Lines ----�______________ Length of each line__._. 0___---_.__ _ Total Len th �� { g ---------- 'D' Box ----------- Type Filter Material --------------------Depth Filter Material --------:-.----------_---------------------- 1 Distance to nearest: Well ________________________ Foundation ------------1_________- Property Lina -----_--_____--__--.-___ SEEPAGE PIT [ Depth -------------------- Diameter ________________ Number -____________- ---------- Rock Filled:-` Yes 7[] No ❑� Water Table Depth ------------------------------------------------Rock Size -- ------------- d Distance to nearest: Well ----------------------------------------Foundation ------------------- Prop. Line -------------_._-_---- REPAIR/,ADDITION{Pie v. Sanitation Permit# -------------------------------------------- } P Date ------------ --•----------------- ,eptic Tank (Specify Requirements)- ----------- --- _ --------------- --- ._ - ---------------------------••--------------- t „.� Disposal Field (Specify Requirements) 1----------- -------------s._.. ------------_�_1_______-__________-_____ ---------------------------------`------4 t �--., r' wi v --------- = -- ------- ---------------------------- ------------------------ p I � ---- ----- ----- °- -----------1--1------= --- .................. (Draw existing-and-required_ad.dtion on.reverse side) I hereby"certify that 11 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 listen- sed agents signature certifies th4'following: I "1 certify that in theperfo�mane of the work for-which this permit is issued, I shall not employ any person in such manner as to become subject Workman's Compensation laws of California." Signed . 4x1 ------ - ------------------------ 'Owner -------------------------------------- (If other than own I BY --------------------- - _ _-- _ Title W"FOR fARTNifNT` 5E ONLY s r: APPl1CATION ACCEPTED BY -- ---- - ------ ------------- ----------------------------------------------------- ------. DATE {- r- r BUILDING PERMIT ISSUED----- - -- ^.__. --- ------DATE -- -- --------------- �--- ----------==:--------------------- --------------- - --------------- ADDITIONAL COMMENTS ---------------------------------------- - -- =- '�-- - -- ------------------------------- r --- : --------- �k --� ` i;�----------------------- -------- --------------- ------- - : r t _ _ -- ------- --------- --- r�-y--- 'Y' ___________________________________ ______________________________________________________________________________• r'a't Final Inspection ------ -- -------------------------- ' ` . Y- --------------- - -- - --.- --- ------------------------------ ------•------- ---:.Dated.--- - �i SAN JOAQUIN L AL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M