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FOR OFFICE USE: -s r APPLICATION FOR SANITATION PERMIT 73-COY/ ------- (Complete in Triplicate) Permit No. - .__---'--- _- 7 -- -- Date Issued - / 7 •, This Permit Expires ] 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 1 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .---- .r'��L�, ------------------------CENSUS TRACT --- ---------- Owner's NamePhone Address _� = .1- 1 cityf> Contractor's Name ---- ---- # -- hane -_ tea a -------- Installation will serve: Residence `Apartment House❑ Commercial ❑Trailer Court ,❑ Motel❑Other -- - ------- -- Number of living units:------------ Number of bear ,�t�s --�__Garba_ge Grinder ---------- Lot Size ------17�-� •----- Water Supply: Public System and name ------------- d' - -- --•- ------------ ---------------- - -- -- Private ❑ Character of soil to a depth of 3 feet: SandE] Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam.F] 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 --------------------- � f°[S�f✓ Capacity� Y ----------- ------ Type --------------------- Material-------------- ------ No. Compartments -------------••------• � Distance to nearest: Well ------------------------------------Foundation ----------- ----_- Prop. Line _-- _-____-_-_. LEACHING LINE [ ] No. of Lines --------- -------------- Length of each line-.------. _-------- Total Length ---- ----------- _ -'D' Box , Type Filter Material _--/ ^Depth Filter Material ------ G f e Distance to nearest: Well Foundation t___- Property Line --_ -------------0 SEEPAGE PIT [ ] Depth ------ Diameter ---.3 --- Number _--------f---- ----------- Rock Filled Yes l/jet S'fe0,1 Water Table Depth -----------Zo--+-------------- -----------Rock Size -�-X -2 r ------ -----�------- Distance to nearest: Well ----__�f ---------------------Foundation .��!-r--_'`_-- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------_-- Septic Tank (Specify Requirements) --------------- - ---- ----- ----- Disposal Field (Specify Requirements) ------ ------------ --------------------------------- - --- --- - - --------------------------------------------------------- raw 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 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 ct to Wo mov'ss Compe tion laws of California." Signed ....... -- ^� f. -� 'r Owner BY ------------------------------------------------------ itle (If other than owner) --- ----------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_----- DATE BUILDING PERMIT ISSUED _____ ___ ___ __ DATE ------------- ----------------------------- ADDITIONAL COMMENTS ,�' � �/ ----•--------------------------------------- { ' --------------------------- -------------- _ ---------------------------------------- --------------------------------------------------------------------------------------------------------------------- -- - Final Inspection b P Y- --------- ------ - -------- ----------- ------------ ---�- ------ ---- - -- ----- -------------.Date -- -3 -�--- - ------------- - SAN JOA E. LOCAL l-IEALTH DISTRICT E. H. 9 1-'68 Rev. 5M