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FOR OFFICE USE: ----- --------------------------------- APPLICATION FOR SANITATION PERMIT ------------qlll---------------- ------ (Complete in Triplicate) Permit No. __73_�� ----------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Ah,?--- 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 nd existin Rules nd Regulations: JOB ADDRESS/LO(! ._ JAW 0h / ----------------- CENSUS Owner's Name - o -------------Phone Address ` V Ex 3HO-------------------------------------------- City Contractor's Name ------- (M -------.License # ----------------------- Phone Installation will serve: ResidenceApartment House Commercial ❑Trailer Court ;M Mote❑Other------------------------------------------ Number of living units:------J---- Number of bedrooms _,____Garbage Grinder ---------.-- Lot Size e 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 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 TANX l ] Size ---- Liquid Depth -------�.-------- Capacity j,1-6--a----- TYPe�f?- -<_a_-$_(Material____ __Q_�___C_ No. Compartments __________ _.___- Distance to nearest: Well 1 Foundation - Q - Pro Lin LINE p J i� --------- LEACHING [ ] No. of Lines __ ____ � __ Length 'of leach line___ g /•�` -- --------------- - - Total ('r70. r ,g� D' Box _____ _____- Type Filter Material _ ';�' t Filter Material --------- /::07 �� Distance to nearest: Well ___ ________-__ Foundation- _____-_Q__-_______ Property Line --------,t /EaE4iPIT' - -"`-"--� [ l Depth -------------------- Diameter ---------------- Number - - _______________ Rock Filled Yes El No C]Water Table Depth ---------------------------------- Rock Size Distance to nearest: Well ________________________________ _______Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# --------_--------- ------------------------- Date Septic Tank (Specify Requirements) isposal Field (Specify Requirements) (Draw existing and required addition on reverse side) - ---------------- I hereby certify that 1 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 beet to W rk cogs Compensation laws of California." Signed -_ ' --------------------- Owner By --- -- - -- ----- - -------------------- Title - -ner)--------------------- (I other than owner) -------------- ------------------------------------ D P RTMENT USE ONLY APPLICATION ACCEPTED BY :- , BUILDING PERMIT ISSUED _ __ _-_ - ---- - - - --- -- - - ------ --- ------------------ DATE ----�-----�--^-- - ADDITIONAL COMMENTS --------- -- -- -- ---------- -`--- - --- ------ ---------------------------DATE ------------- -------'J --------- ----------------------------------------------------------- Final Inspection b _ ---------------- ------ ---- --------------- --- -- -------------------------------------------- ----------------------------- ----------Date _ "- '_ SAN JOAQUIN LOCA'_ HEALTH DISTRICT � E. H. 9 1-'68 Rev. 5M