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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- - ------------------ -------- Permit No. ----------------- - ---_ - ------ (Complete in Triplicate) - - - - ,3 .3d -73 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 hereir. described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ----- --- - ---------------------- -- - CENSUS TRACT ------ Owner's Name --------14)_0 iJ RT------62 -H-R-0—N-------------------------------- Phone �/ C �/ ) -- i------------------------------------------------ Address ��-� / -`J/-,�/V.�-�- ----------------------------------. City __.M-7-C-19- Contractor's Name > _VVL1i'C License # ------- ---------------- Phone -----------------------_--- Installation will serve: Residence (Apartment House L7 Commercial ❑Trailer Court ,❑ Motel ❑Other -------------- --- ------------------- Number of living units:-----1---- Number of bedrooms ___3----Garbage Grinde/r- Lot Size -'S -----eo*l_z --------- Water Supply: Public System and name -------------------------- ------------------ ---------------- ----------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam e Clay Loam ❑ Hardpan E!r". Adobe ❑ Fill Material _M'? 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 ublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size- � __X `�- .__-_-_-- Liquid Depth _. -_-----_---- Capacity _, f- ----- Type _ r A!3- Material_ Cr/V( -tR ` No, Com artments r Distance to nearest: Well --.-- �-t7_-_-4'_-___-_____-___Foundation -L '-4--------- Prop. Line ---:__- e LEACHING LINE kj No. of Lines -_ --,�__----__---_ Length of each line-___-• -- ------ ------- Total Length _-__ �---------. ^ 'D' Box � Type_ Filter Material _Q_ _ __Depth Filter Material _-.-- _ _1-___-___-___________________ Distance to nearest: Well ------ -_. Foundation --- -_:" --------- Property Line - -___-_______-__-_ �- SEEPAGE PIT [ ] Depth _ ----------------- Diameter ---------------- Number -------------- _ --------- Rock Filled Yes ❑ No i❑ Water Table Depth -----------------------------------------------Rock Size ---- -------------------------- Distance to nearest: Well _---.-----------------------------------Foundation -------------------- Prop. Line __,___________________- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---------------------------------- Date _-___.______-__-_.--------------) Septic Tank (Specify Requirements) ---------------------------------- ------- -------------------------- DisposalField (Specify Requirements) ----------------- -------------------------------- ---------- ------------------------------------------------------------------- ---------- -- -- ----------------------------------- ------------------------------------------------------------- ----------------- ------------------------------------------------------------------ -- --------- -------- ---------- - ------------------------------------------------------------------------------ --------------------------------------------------- \ (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 c County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- �V sed agents si ature certifies the following: "I certify t at in a pe orman'jce of a work for which this permit is issued, I shall not employ any person in such manner /, /t �4an's ompensation laws of California." (> as to bec su jec ---- ------ Signed - L�1 ✓ Owner BY - - - -------------------- ----------- -% * Title -- - ----------- - --------- ---- ----------- ---------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ -------------------------------=------ ------------- -----. DATE 3-"-Z -- .73---- BUILDING PERMIT ISSUED ------ ----------------------------------------- --------------------------- -------------------------DATE - ---------------------------------- ADDITIONAL COMMENTS ------ ----------------------------------------------- - - �- ---------------- ---------------------------------------------------------- -- ----- -- ! -- -- \--- / - ---- ---------------- -Z/" - - ` Final Inspection by: -��j �f-�---- -- (�. 6✓1� 1 Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M