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FOR OFFICE USE- -? . t-0 APPLICATION FOR SANITATION PERMIT ............ ......... tCrpleteoin Triplicate) Permit No. ..73.'........... _............ This Permit Expires 1 Year From Date Issued Date Issued ... ...........7.. 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: JOB ADDRESS/LOCATION .......g. .. .................../.t..5.A ..........................CENSUS TRACT ... ...... ........_.�... Owner's Name .......`I ................................... .....:....................Phone . ... ..... Address ..............10 ................... ........................... City ......5ft...C4.`*/*" .................................... Contractor's Name ..: 1.c!�.0 .t'�o�-:c� --.,, �o j�, rji.I.-....License # 9 .1... Phone Installation will serve: Residence j3 Apartment House Commercial ❑Trailer Court 0 Motel ❑Other ...............--•......................... Number of living units:.... ../..... Number of bedrooms ....._ ._...Garbo a Grinder ............ lot Size ......A:!tV.11,a: i ......... Water Supply: Public System and name .............................................. .............................................................._Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam I Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Moteriol ............ If yes,type ............................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be, placed on reverse side.) "1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKQ Size...... ... '1..��z/�. .............. Liquid Depth ........�. ......... d capacity Type .:.fes......... Material4wZ!t.kre.�. No. Compartments -2................. e _ Distance to nearl:st: Well .._._..._ r .f1.............Foundation .....1.49..`..... Prop. Line ...1626 ..:.... LEACHING LINE (K] No. of Lines .... 1............. Length of each line..........S42.......... Total length ............ 'D' Box ....J_..... Type Filter Material .......c.Z.r...Depth Filter Material .............1.�7_....................... Distance to.nearest: Well .....4� .`..... Foundation ....... ..'*...... Property Line ._�`��. .._ SEEPAGE PIT p(J Depth ....rX .�/�.. Diameter ... " Number ..........2.............. Rock Filled Yes ($ No Water Table Depth 9$0,.. .................. Size ............cq...`.,......... Distance to nearest: Well ....v .`......................Foundation _2.e.0 Prop. line ..1.1.x............. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) Septic Tank (Specify Requiremernts) ...................... .nom ... . _......_ Disposal Field (Specify Requirements) ....... / ._. .c.?sz,%......4........ ................... . ...... .................................................................._................................. ..................................... '.----•-•---------.........-----•-- --------------- ------ ............. -•--------------........._..---••---•----------•--•.....-••••--•-••-._.-----•-_._......................--•---•.....•--•--•---------•-............_...._......••_.. (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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Meme owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------....-•-------------•---•----...../.......------............................._...._........ Owner By .._.... .. .G. i . Title ..... ........................... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... _. ..._.. DATE ... '...,/�1..:.......7... ••-- BUILDING PERMIT ISSUED ..........................................................DATE ....•...................................... ADDITIONAL COMMENTS ........................... ...... . ....... ........•--• ....................................................................................................... -------------•-------•-------............... .......... - -------.............._... Final Inspection by •...................................Date ...L..."r . SAN OAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M 7/723M