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FOR OFFICE USE: LAI APPLICATION FOR"SANITATION PERMIT P,�rmit I�o: --73 (Complete in Triplicate) ----- ._______________ -- --- -------------------------- This Permit Expires 1 Year From Date Issued 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 County Ordinance No. 549 and existing Rules and Regulations: 7 JOB ADDRESS/LO ATION ._�, uSUS TRACT Owner's Name /� ff - Phone ------------------------------------ �- 171 - Address - -- ----- --- ---------�-�-- - -------��-----��!4_i_�i�-----------. Cit - F''- -`-�------------------------------•------ Contractor's Name ___l� 1.� __________________________.__._____.License #d' ----- Phone __ �- _ ?__. ICf� - Installation will serve: Residence [�artment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:-----1------ Number of drooms __ --------Garbage Grinder tr _ __ Lot Size _g 4-14e---------------- Water Supply: Public System and name __ _ 4'` __ - __________ _____________________________________Private E] Character of soil to a depth of 3 feet: Sand'❑ A❑ Clay EJ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ___/V' ' 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) > PACKAGE TREATMENT [ ] SEPTIC TANK Size______- x_..�l_ �_____ ______ Liquid Depth __ /2P.......___. Capacity _-S�ab------- Type :t.� _ Material___ _ .-1,-V No. Compartments __ .............. Distance to nearest: Well _-___-V- ___________________Foundation ------------ Prop. Line . �._---____-__ v i LEACHING LINT: No. of Lines __ __ Len th of each line__ __ Total Length[ -------- � -�S -- g '-f'---------------- 'D' Box ___ �,_ Type Filter M terial _ t '.__.Depth Filter Material -------------------------- ................. Distance tdJnearest: Well __ / _ _____________ Foundation __l_�_�_-____-____ Property Line .__..____._..__ SEEPAGE PIT [� Depth _ ./' _ Diameter .�-�'_'�______ Number _�� _ __ _________ Rock Filled Yes '�o i❑ - ---------- - Water Table.Depth ---------(o. 1 t/ ------------------------Rock Size - � -x-�-------------- Distance to nearest: Well ______/1/� �-----------------------Foundation ___/-,0-/_..___ Prop. Line .............. REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) ------- ------------------------------------------------------------------------------------------------------- ---------------••---------- Disposal Field (Specify, Requirements) ----------- ------------------------------------------------------------------------------------ --------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 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 to Workman's Compensatio'h laws of California. Signed ---------- ! ------------------------- Owner BY ----------------------------------- J�+-.c ------------------------ Title ------ Q_�,1� - - -------------------------------------------- (If other th ner) //�� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --1----t ` - - - ------------------------------ ----------------- DATE �a-�7 3----------------- BUILDING PERMIT ISSUED ------- - --------------------------------------- ------ DATE ------------- ----------------------------- ADDITIONALCOMMENTS -------------------------------------------------------- --4----------------------------- ----------------------------------------------------------------- �3°��3 - --------------------------------------- ------------------------------------------------ ----------------------------------------- ----------- ------------------------------------ ---- ---- - ------ --- FinalInspection by: - ----- ---------=--------------------------------------------------------------------Date -----— ��9Z---------------- t SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M