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FOR OFFICE USE: APPLICATION FOR SANITATION PER • MIT ----------------------------------------------"---_-- -- .` .T. Permit Nc. __7.3---?S— - (Complete in Triplicate} - ---------- ----- - This Permit Expires 1 Year From Date Issued Date Issued _10_-ZX:73 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: r ' 106 ADDRESS/LOCATION -----V0-3_ �_ _._ !@1�� - ._._-_CENSUS TRACT ---------................. -- Owner's Name / I------411AS-P,41V-------------------------------------------------- ---------------------Phone ----------- ------------------------ Address --------gel��----------5.-----/,/""v C0/4�-----5 --------------------------- City Ta m ---------- Contractor's Name ----------/ �----------------------------- -------License #622; 7.c�_ 'a__ Phone ak5_7_9_14�1 -- Installation will serve: Residence 7ApartmeA-Vlq;ause7❑ Commercial [Trailer Court ❑ „ Motel ❑Other -------------------------------------------- Number of living units:-----I------ Number of bedrooms _______Garbage Grinder ------------ Lot Size ------/Ac 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 ---- -------------------- -(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 feetZ le ,) // PACKAGE TREATMENT f ] SEPTIC TANK. ] Size---�Y_-��VY_4_--------------- Liquid Depth ___.r__5---__---_,----_ '�•- - —s�.a.r a-Y�- .z-r---- rink 4 opacity MaTeria}_______--------------- Distance ___ ______ 'No.n'Com-artments"_ P Y TYPe i Eri s/ ' p .._---- y Distance to nearest: Well Q_______________________Foundation ../0-_____.___._- Prop. Line .... �y LEACHING LINE No. of Lines _____ - Length of each line._-___ _W Total Length -_6V [ z P ---- .-"D .............. " Box ; + ----- T _ YPe Filter Material __/ _-_- Depth' Filter Material-- -__:,� _______ ________________ ` Distance'to.We'arest: Well ---------- --- -___�Foundation 1_-LJ-------------- Property Line --_-_ ............. SEEPAGE PIT [ ] Depth _---_-.-.---":__.___ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table,Depth -------- ------------Rock Size -------------------------------- f Distance to nearest: Well -------_)--- __ --------- -------Foundation "`---=--;._..w_ Prop. Eine!-----=- REPAIR/ADDITION(Prev. Sanitation Permit# -------________------------------- _ -------- Date ------------------------------___.__} ; Septic Tank (Specify Requirements) i .. =------------------------r---- ---;-------------------..- Disposal, Field (Specify Requirements) --------------- ----------- --------------- -------;------' ----------- 1 _�_ -----------------_-------------------------------------------------------------------------------------------------_---------------------------------------------------------------------- '---------------- (Draw existing and required addition on reverse side) j I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Stag 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 t Work an's Compensation laws of California." ; Signed___;-- '., _ _._ ;- _�.,,w-_,_, Owner-- By wner-Y Ti#le (If other than owner .' t FOR DEPART NT USE ONLY APPLICATION ACCEPTED BY ------ ---------- ---- ------------ ------------------------------------- -----. DATE6 = BUILDING PERMIT ISSUED ----------------------------------------------------- ------- --------------------------- ----------- --DATE ------------------------------------------ ,DDITIONAL COMMENTS -------------------- -- --- -------------------- ---------------------------------------------------------------------------- --------------------------- ______________________________________ _ __ _________________-. -----.-----------------.------------------------------------------_----------------------- ----------------------- - -______-------___ -- ---------------- _ ----- ------- _---_ - - --____-_-_____----.-____--_---__--________-__-____--____-____--__-______ z _ --__ Final Inspection by: --------------- ----------------- -------.Date --- --- -- -- ----- - -- ---------------- SAN J QUIN LOCAL HEALTH DISTRICT � I E. H. 9, 1-'b8 Rev. 5M.