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FOR OFFICE USE: f APPLICATION FOR SANITATION PERMIT ................ . .. . . •..-----.... (Complete in Triplicate) Permit No. ..73.-...... „-. ` I, 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 County Ordinance No. 549 on existing Rules and Regulations: JOB ADDRESS/LOCATION ...... -l`K— ..CENSUS TRACT .................... ... Owner's Name ........ �lG ............................................................................ _....Phone .................................... Address ................./3 8 3••-St . t£�P-,�,r,r... ....._......... 0ty,�`��7Z.- ...... • ....... Contractor's Name ......... G�_.�?C__•..........................................................License # Phone Installation will serve: Residence partment House 0 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 ❑ Clay loam ❑ Hardpan❑ Adobe ❑ Fill Material ............ If yes,type............................ (Plot pian, showing size of, lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK t ] 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 ❑ ! No ❑ -- Water Table Depth ....Rock Size Distance to nearest: Well ................................:.......Foundation .................... Prop. Line ....... .....-------- REPAIR/ADDITION(Prev. Sanitation Permit# ........... ......................... ..... D ) Septic Tank (Specify Requirements) .._ _ ':E -< --C�c�t. �. � f�J�r�� ---- - .. .... _ . .Dis osal Field (Speci Re uirements) .. ..404�... .. ...............sJ .rs.✓ G 4r.______......,'._..__..__._.. P (Specify 9 -------------- ----------------------------- -------•------•-------•-------------._......---•---•----••-------._...----•-•----••-----._.....-----------.._._.._.__.....-•--- •-------- .........._..- ..-•-- -------------------------------------------------------•--------------•---•-••-------------.-._..-•-----.._.................._........._.._.._.._....---...._._.._...._._._..,....._.__..__. (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 licen- sed agents signature certifies the following: "I certify that in the rf mance of the k for which this permit is issued, 1 shall not employ any person in such maturer as to be ome subi o orkman's sation laws of California.” Signed ----•- ••-- - - ------- -- ---•-••- • •- .... ._....... Owner BY ..................................................- - ---•---___------.... . Sitle ............ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........ .....✓...... ` c<c,.--.................................................. DATE ..... ...... BUILDING PERMIT ISSUED ..............DATE .............................,.........-- ADDITIONALCOMMENTS ......................•-•---...................-•---.............._._................_.................._..---•--•--..............:.._........._1............. ................... •-••----------•......................................................................................................................................................... _._...._...... .......................••-----.._.......---...---•--..........._...:............._._.._......_....._.._....----....._................................_......................._........._.._......_....._.. _...._.._... ... .......- - , F' al Inspection b .�.' .:�--...................................... .Date ..II'- .�-2._3............... SAN JOAQUIN LOCAL HEALTH DISTRICT L10 E. H.13 J4,1-'68 Rev. 5M 7/72 3 M 1.6