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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 73 16( Permit No. _._--.--- -------- ---------------- ------------------•- ------- ----------- (Complete in Triplicate) --------------------------------- ------------- Date issued �� ----------.. ------- -------------------------------------------- --- - This Permit 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 application is made in compliance with!/Co linty OrdinanceNo. 549 and existing Rules an �,� d Regulations: JOB ADDRESS/LOCATION -:--46��7--=_-- —?-=- ,C S'9Tlz.��G. __.-.`_– CENSUS TRACT ------------------ Phone --------------------•----------•---- Owner's Name - ---- -� --------�'t_A_7 7C-----------------------•----------------------- - ,�..� City _,j_ T _1 ----------------- -------------------_---- Address ----- l------ ---------------------- -=:------------------------ ---------.. _ Contractor's Name ---- V-------------------- ____.License #p �� _ Phoner -1�� Installation will serve: Residence XApartmeni,House❑ Commercial {]Trailer Court ❑E Motel ❑Other ----r--------------------------------------- Number of living units._-_J-- -- Number of bedrooms ____a?----Garbage Grinder Lot Size -------------------------------------------- ' � -----------------Private ❑ Water Supply: Public System and name ----- _ , `rx� _fi-� v. � ------------ - -------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i Hardpan ❑ Adobe ❑ 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,) E PACKAGE TREATMENT Size------------------------------------ ------------ Liquid Dept -------------------------- { ] SEPTIC TANK' Ca a6t Type -------------------- Material----------------0 No. Compartmen s __ Distance to neares#: Well ------------------------------------ No. ________ _ _ Foundation _______________ Prop. Line ___.___-____..__---.__ M1 - --------------- 1 -- Total Length .___ -.--- LEACHING LINE [ ] No. of Lines ; ! - _ Length of each line-------------------`---- ----•------------- J k ---_De Depth Filter Material _----------- --•----------•-- 'D' Box _____--j--- Type Filter Material ________________ p Distance to nearest: Well _____________ ------ Foundation ------------s ------ -Property Line -------- --------------- SEEPAGE PIT' [ ] Depth -------------------- Diameter --_------.------ Number -----------------; --. -- Rock Filled Yes ❑ No �❑ + f Water Table Depth --------------------------------------------` Rock Size j i Foundation - Prop. Line ---------------------- 1 Distance to nearest: Well _____._______________________ __ tri ` I --------- -F------- ---------- Date -- ------fI-----------------:--) REPAIR/ADDITION(Prev. Sanitation Permit# ------------ Septic Tank (Specify Requirements) I---------------- � ------------------ ------------------------------------------- Disposal Field (Specify Requirements) --------------------------------- ---------- -------- - -----------�------- ------------ -------------------------------------- - - --------- -- --- ---- --- -------------------------------------------------•---------------------------- ------------- --------------------------- 1 (Draw existing and required addition on reverse side) .I 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 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 Wor man's Compensation laws of California." i Signed - ----------------------------------------------- Owner i --------- Title ------------------- ------------ -------------------------- YF(If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ _ -- - ------------------ ------------- ------------------ DATE}---Z/7e6;'� ---------------- -- •------------------ ---------• BUILDING PE~RMIT_ISSUED-------------------------------- - -- --- ---------------------•--------- -------------DATE �.---------- ADDITIONALCOMMENTS ------_-------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------=---------------------------------- --- = - ------------- ----------- ------------ ---� - Date --`---- - ----� ------ - Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M