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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit-No. ------------ ----------------4711- This Permit Expires i Year From Date Issued _ Date Issued !i_`' _��3_. 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 r)a_1'WJ_1?____cFartn?s--- TRACT ----------- Owner's Name ----- ------ '.�_[r4�_lS------------- --- Phone ------------------------------------ r Address --- 3 y L7 -_01......z�� - --------------------------- City ��_�L 7��T� Contractor's Name --- A_ylL?-e-------- l��3-1_C1l-------------------------License # _S.51W Phone ---13--6--- Installation will serve: / Residence 99-Al5artment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Number -- ----------------------------Number of living units_____________ Number of bedrooms ______Garbage Grinder ------------ Lot Size ____-_-__-___-__________________________.__. Water Supply: Public System and name -----------------------------------------------------b• ��-------•-----------------------------------Private } Character of soil to a depth of 3 feet: Sand'E] Silt E) Clay �eattandy Loam ,E Clay Loam ❑ Hardpan e�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.) v NEW INSTALLATION: (No septic tank or-seepage pit permitted if public sewer is available within 200 feet,) Q PACKAGE.-TREATMENT . [ ] SEPTIC.TANK [ ] --------------------- Liquid Depth ---'3--�--- r, g --------- CapacityM ______________________ Not Compartments �----------- ------------------ c Distance to nearest: Well r__ __0 Fou __ ndation --- - ------------- Prop. Line --- _a___ LEACHING LINE [ ] No. of Lines -- Length of`eafh ----------- Total Length c ---`_2,_0.......... 'D' Box .___1------ Type FilterMaterialf 1:1---MCIkbepth Filter Material -----te--------_----------------------- � Distance to nearest: Well __.... ____;�f Foundation _:_� '____-_ t_-----_ Property Line _- __d•__..•_..._ SEEPAGE PIT [ j Depth __ _��_'_:___ Diameter _-�. ----- Number -----------3-_--- Ag Rock Filled Yes [�No i❑ Water Table Depth -----------------Q-0--.................Rock Size -------1 X----------------- K Distance to nearest: Well __0.0-------------------Foundation __2-------------- Prop. Line ----�.Q___--_-_ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________) SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------- .------------------------•-- Disposal Field (Specify Requirements) --------------------------------------------------_--------------------------------------------------------------- --------------- ----------------------------------------------------------------------------------------------------- -------------------------------- ---- ----------------------------------------- --------- ------------------------- ---- --------------------------•-- --------------------------- ---------- - - - ------------------------------------------------------------------ - (Drawexisting'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 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 subject to Workman's Compensation laws of California." Signed ------ - Owner ---------------------------- BY Title - = other than o59 wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --- -- ------ --- DATE __�_t?_.-_P-3_'73___•---____-- ----------------------------- BUILDING PERMIT ISSUED ------------------------------------------------------------------ --------------DATE ------- ------------------I--------------- ADDITIONAL COMMENTS ----------------------- - ----------------------------------------- e�,,r �..._z-{ ------------ ( � --- --- ------------------------------------------- ----------- Final Inspection by: -- --------- fDate SAN � ~ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M