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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _73 ...... --- - --------= -- --- - --- --------------------- Date Issued -_�/__ 7-3 ________________ This Permit Expires 1 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 incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION-?"'i�-_�gj_- ., aPa _ � .--,----- CENSUS TRACT __- _ Owner's Name J � _.,__ Q�11Q --------- ----------- ------------------------------------- --------- Phone _: _ _ . Address T ` ' r "',GP � wQf�.% -------------•--. Cit ��p Contractor's Name _.rZe—b'd�✓-----------------------------s--------------------- ------License =3 C?---- PhaneG Installation will serve: Residence [] Apartmett',House,❑ Commercial:❑Trailer Court' ;❑ Motel ❑ Other Number of living units:-_�_f__ Number of bedrooms ---_t`_Garbage Grinder -----I____ Lot Size; z�-�__.tf''-c'1F'�.S"�________ Water Supply: Public System and name ________________________ __-_________Private i 3 �/ - � Character of soil to a depth of'3.feet:.__,Sand.''5 .SiltGa } t y ❑ Peat-E] Sandy LogrQ_ _Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type __ --------------------- ------ 11 � E;F (Plot plan, showing size of lot, location of system in r ration to wells, buildings, etc. must be placed'on reverse side.) NEW INSTALLATION: (No septic tank or see age pit permitted if .blit sewer is available w-.- 200 feet,] - Ae PACKAGE TREATMENT { ] SEPTIC TANK: Size_/___, 1 -T --- '- Liq id Depth T _ _ _______ Capacity Sloo-------- TYp/402'n3W_ _ Material / ' '] No. �Co partments ______---------__ c�' �01 .11 Distance to nearest: Well -----Z_,0----------------------F,oundat on -/a------------- Prop. LineQ ------ ----•- I LEACHING LINE [ No. of Lines �_-_____________- Length of each-line-___ --- �g ��p --------------- Total Length �07' Q--�--------...----- 'D' Box �ifa_-__ Type Filter Material _„ _l�`______Deptrh� Filter Materia) ______________ __ -------- Foundations. ---------------- Property Line � _ � _.__'_ Distance to nearest: Well Y. , SEEPAGE PIT { ] Depth ___________________ Diameter ___ --------- Number ---------------------------- Rock Filled Yes ❑ No- Water _Water Table Depth -------------- epth %- ----------- -�----------=----------•---•-----.,Rock Size ------- --------------------- - Distance to nearest: Well __________ T " ---____--Foundation -----__-_--`-"`�_ -- Prop. Line,_. (Prev. Sanitation Permit# _______.____"_ -________________________ Date ----------------------------------- Septic ___--_______-_ __------Septic Tank (Specify Requirements) _____________________________ 1- - ---------------- Disposal Field (Specify Requirements) __________ _________i 2- ft _._________- --------i-- ------------------------------ - .. -------- --------------- -- ------{ ----------------------_---.-._--_---------------.,----- - -------------------------------------------- (Draw existingand re- uired 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: fj "I certify that in the performance of the work for whichjtHis 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 ��/#'Y6, (lf other than owner] e �---�- p FOR DEPARTMENT USE ONLYI APPLICATION ACCEPTED BY ._ � �"1-��'�---------------- �-------- -- - -- ------------ DATE ------ -' --- -- BUILDING PERMIT ISSUED i DATE - ----------- --------- ---------- - ---------------------- ADDITIONAL COMMENTS )F�------ --- -- •- - --------------------------------- ------ - ---------- ------- --- 1 a�--- - --- ----------------------- ----- , ------------- --- -------------- -- - -------- ----------------------- -- - ----- --------------------- -----------� - -------- - - Fina fnspectio ------------.Date 4 SAN JOAQUINy-LOCAL HEALTH DISTRICT E. H. 9 - 1-'68 Rev. 5M