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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 73-,4?:_.'.... .... A- Permit Na. ..._ .. . ....a..6 i (Complete In Triplicate) ... Dote Issued �! /� •--_..... This Permit Expires i 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-and existing Rules and Regulations: 33 ._...� •--• .. . ... ...........................CENSUS TRACT ...::........... JOB ADDRESS/LOCATION .:........ .._. .._ Owner's Name .�u�4•.r...--pa[.a.hftQ..........................................................................Phone .... -•- -•--•g4..:_- Address ..-•--------------------- ......................................... City ------......................................- = _--�......._._......... . ... ..... . Contractor's Name ._._.....' ............License # ��r �� 3--- Phone Installation will serve: Residence ❑Apartmen_t��HHJouss/e-E)-Com�[mercial 0TrailerCourt Motel [Other --- Number of living units;-------I._. Number of bedrooms ___3_.:Gbrbage,'.Grinder ..__-...___. Lot Size .._ -s.lT ......................... Water Supply: Public System and name ------------------------- � .-,-------- -------------------------........-------- Private i Character of soil to a depth of 3 feet: Sand 0 . Silt[3 �Cly-©_fat❑ Sandy Loam fl Clay Loam I 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 TANK Size............................... ................ Liquid Depth .......................... Material---QR o. Compartments _Z1......I......... uJ Capacity t_ -.`�-._-.�'fYPe --=�'-- - Distance to nearest:�Well .__..:S0--_l`...................Foundation ._.fo.. ....._•__ Prop. Line _.ld___........ .-- LEACHING LINE [ J No. of Li es ......... ......... Length of each line.-----jV.57........... Total Length _.___.Tp............... ,,. 'D' Box ..3-_ -. � .- Type Filter Material S _....Depth//Filter Material ..A. ................................... Distance to-nearest-Well ........15 ......._ Foundation ...... Property Line -- -r ............ P SEEPAGE PIT [ Depth ...- S....__ Diameters-- ...... Number ..A- ------•-•-•-•-- Rock Filled Yes ] No [] r• `'` .____Rock Size may....-. Water Table De th ___ .----------•----•--••-• --------------- Distance to nearest:'Weli ...... ...............Foundation _.` 5'_!�....... Prop. Line . •----.- f REPAIR/ADDITION(Prev. San itafio`n.Permit�#', ............•......---------------•-•••••. Date .............................. ----) SepticTank (Specify Requirements) . ..........:.. ........................... ......... .............•--•-......................... .......... ................ , i Disposal Field (Specify Requirements) .................. i F ----------------------------------•-- -----------. ......... --------------------- ---------------_.....--•---------------------• ---------------------•--------------._...,------ ........I.-•-----_.._....__._.... (Dfaw existing and required addition on reverse side) I hereby.certify 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, Hoene owner or liceet- i sed agents signature certifies the following: "I certify that in the performance of the works for which this permit is issued, I shall not employ any person in such manner as to become subjectto W kman's Compensation laws of California!' Signed ----- --------=--- ......... - )-•----------•--- Owner ... (If other than owner) O ARTMENT USE ONLY APPLICATION ACCEPTED BY --• ---- -_.. .. .. • . --- .......................................---------_.... DATE -•..- BUILDINGPERMIT ISSUED ....... ... .. .. .... .. ..... .... •• . .........................,.............................DATE ._.-......-----------... DD1TIONALCOMMENTS ..... .. .. . . .. ...... ...... ..... ..... ...........-._...........----..............................••--....---..__,:.. .............. ...... ................. a: ::_: -------------••-•--. --........---........-- ----............., ----- ....... ...... : ----------------------- •-._----- - ._.. -• . - ............................_..........-................................................. FinalInspection by: ............ ..... .. ..... . ......-----.......................................................:...........Date ..... -•---•--- N J AQUIN LOCAL HEALTH DISTRICT r-_ k_1-3 241-'68 Rev. 5 - 7/72 3 M