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FOR OFFICE USE: APPLICATION POR"SANITATION PERMIT -------------------------- Permit No. 7-3_—w�--- (Complete fn Triplicate) � r Issued t, Date issued -__------_-_------_-___----_------_----_----------- V This Permit Expires 1 Year From ate ssue 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 County Ordinance No. 549 and existing Rules and Regulations: ---CENSUS TRACT -------------------------- JOB ADDRESS/LO TION . ! "t- ------P'_-- `-- Owner's Name : " -- Pho Address --�&_�q-- 7 F ------------- - City c Contractor's Name ----------------------------------------------- ------.License # --------------- -------- Phone --------•------ ------_------ Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ----- -------------------------------- Number of living units: Number of bedrooms ____Garbage Grinder _________ Lot Size ______--__-______________________________ Water Supply: Public System and name ---------------------------------------------------------- ..............................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam lay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type------------_______________ (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (L NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) H PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size-----------------------------------.------------ Liquid Depth .-----------------_------ Capacity ------------- ------ Type -------------------- Material------------ --- No. Compartments ........... Distance to nearest: Well ________________________________Foundation ---------------------- Prop. Line ...................... LEACHING LINE [ ] No. of Lines ------------------------ Length of each line----------;------------------ Total Length ___________________-----_- 'D' Box ----- ------ Type Filter Material ____________________Depth Filter Material ____________---____........................ Distance to nearest: Well ________________________ Foundation ------------------------- Property Line ........................ SEEPAGE PIT [ ) Depth ________________ Diameter °___ Number ------ --------------------- Rock Filled Yes '0 No 0 Water Table Depth ------------------------------------------------Rock Size --------------- ---------------- Distance to nearest: Well ______________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# _______ ------------------------------------ Date ------------------------------------). Septic Tank (Specify Requirements) _ __ ____.._______________-______ Disposal Field (Specify Relluire nts � _ - -- ------ ---- - - ----3'�'f�-=-•--`± UU --._-- --------- ---------------------- -- -------------------------------------------------------------------------------- ---------------•---------------------- (Draw existing and required addition on 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, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that the performance of the work for which this permit is issued, I shall not employ any person in such manner as to becom s bject to Work pensation-laws of alifornia." Signed,----V-- ------ Owner By ---- ---------------------------------------------------------------------- ------ Title ------------------------------------------------ (If other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED B - - -- ------------------------------------------------------------------------ DATE ----/©---='?`Ir."7---73------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------- --------------------DATE ------------- ----------------------------- ADDITIONAL COMMENTS ----------------------4-- ---------------------------------------------------------------------------------------------- —---...............------ ---------------------------------------------------------------- ------------------------------------------------------------------•------------------------------------------------------- -------- --- 73 Final Inspection by: -- --- -------------------:,..----------------------------- -----.- ��-- .--------. Date _ _______' SAN JOAQUIN LOCAL'4*_TH DISTRICT T E. H. 9 1-'68 Rev. 5M �A