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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' Permit No. 73----------------- .! �� (Complete in Triplicate) . ------- ---- - '= .'`.- r 11�/ -7- - This Permit Expires 1 Year From Date Issued bate Issued _:____.__�______. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the Iwork herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: iq JOB ADDRESS/LOCATION .�Cl/---1� --- p ( .--- ' '--- ----:-.---CENSUS TRACT -------�i------------------ Owner's Name --- -------- ----------------- -----------------Phone--- ------- :�'---------------- Address --- ------------------------------------- City ---- Contractor's Name -------License # _ Phone _ Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court '❑ Motel ❑ Other .__-=__. _ i Number of living units:------------ Number of bedrooms __________Garbage Grinder ------------ Lot Size ____,e!�q,ee.�T`.............. Water Supply: Public System and name --------------------------- ----------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay eat❑ Sandy Loam ❑ Clay Loam :❑ Hardpan ❑ Adobe ill Material .____.______ If yes, type _________._________________ 11 (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_________tea_X_ r --------------------- Liquid Depth __.�� _r_�___.____. Capacity Type teHal___G. ______ No. Compartments Distance to nearest: Well ------ ---------Foundation _-___AC�____'/__ Prop. Line ____� ,_:______ 100 LEACHING LINE ["] No. of Lines -.-F- --------- Length of each line----- �--------"-- Tota[ Length --------_--- Z, r r li , 'D' Box - __-Type Filter Mater'al _1�X- -_Depth Filter Material _"-_-"� ________ __________________ Distance to nearest: Well ___ _�__ _ Foundation 1p----7'7-- Property Line SEEPAGE PIT [ ] Depth .__ � __- Diameter �7 ____ Number --------.�-------------- Rock Filled Yes ' Q Water Table Depth -------�_ 1--------------------------------Rock Size-____ �:_ -----------!?— j 9 Distance to nearest: Well ---_- ------------Foundation -------- Prop. Line ___ ------- REPAIR/ADDITION(Prev. Sanitation Permit* __--_-_ ------------------------------------ Date ---------------------------------- II Septic Tank (Specify Requirements) ____ _______ _____ Disposal Field (Specify Requirements) _________ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- li (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 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 "I certify that in performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco j ct to Wo km 's Com ensati laws of California." I� Signed --- - --- ------ ---------------- - ----- - -------- wner By ----------- --- ------------------ ------ itle (If other than ner i PARTMENT USE ONLY APPLICATION ACCEPTED BY --- DATE BUILDING PERMIT ISSUE %D _------DATE --------- ------------------------------ ADDITIONALCOMMENTS --- ---- - ----------- - ----- --------------------------------------------------------------------------------- ---------------• --------- ---- - ---------- --- --- - ---------------------------------------------------------------- ------------ --------------------------- ------ ------------ ----------------- ----- - -- ------------------------------------ -------- Final Inspection b ---- ------ P y- ---------------- -----' - -----------------------------------------------------------------Date -- JO QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5 Ij