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FOR OFFICE USE: ��, - APPLICATION FOR SANITATION PERMIT ... ... .......................... (Complete in Triplicated Permit No. ... ....... t -•............................1. Date Issued ..7"�:s-73 I ....... This Permit Expires I 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAL 6N , . .1 .. ...................CENSUS TRACT ............ Owner'3 Name ..... ..°.AR�Z. ..�Y l : .........................................:.........Phone ...��. .' ...--- s �� Address � t`?�' 7. - -------- ........................................... # .� - Phone .__...... �y � Contractor's Name ....-/�`-�. ...-4--• 14�.�re....................................... License Installation will serve: Residence (Apartment House fl Commercial ❑Trailer Court ] i Motel Q Other ----- ......:............ Number of living units:......... Number of bedrooms ..-7-_ Garbage Grinder .... ....... Lot Size -------- Water _...--Water Supply: Public System and name .... -------------------------------...............•........,........................... Private ❑ Character of soil to a depth of 3 feet; Sand - p Silt❑ Clay,0 " Peat❑ Sandy Loam' Cloy Loam Q " Hardpan ❑ Adobe 0Fill Material ............ If yes,type............!--.-___.------- k (Plot pian, showing size of lot, location of. system in.relation ta wells, buildings, etc. must be placed on reverse side.) NEVINSTALLATION: (No septic tank or seepage pit permitted .if_publit sewer is available within 200 feet,) F � PACKAGE TREATMENT; [ ] SEPTIC TANK T ] Size..............:................................. Liquid Depth -......................... Capacity ... Material.--................... No. Compartments ............... Distance to nearest: Well ......:.............................Foundation .......................Prop. Line ...................... LEACHING LINE [ ] No. of Lines ....... Length of each line............................. Total length F 1 n D' Box Type Filter Material ..Depth Filter Material i R ..... ................ Q Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ " SEEPAGE.PITDe th Diameter ................ Number ........_... ............... Rock Filled Yes 0 No Q� E1 p11 Water Table Depth ----------Rock Size .....:.- ... Distance to nearest: Well ..Foundation ..................... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# . ,...---•...--------•--•-----•-•............. Date -- --..... : ...---•-------- 1 Septic Tank (Specify Requirements) ' Disposal Field (Specify Requirements) ................ ..._.....__-- , fT:...-.... /.. _.. :-_.-.--....... J 4. ............................................................................................_......_..--._............-.._.._........................................`...-..-__................_ . . ..... .. ........ ....- -. . . -..... ...........-•---•-••-jDraw existing and required addition on'reverse side) ........-...... .......1.........--•--------------...----- e) 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 Wes-and Regulations of the San Joaquin Loyal Health District..Home owner or [icon- sed agents signature certifies the following: ' }; "I certify that in the performance of the work for which this permit is issued, 1 51;011 not employ any person in such manner i as to become subject o W rkman"s Comper idtion�'Iawf o -QIIfo�nla."4`�" Signed •---------•-�. ..---.. - ...................._................ Owner BY .. --.. Title ...........\: : . ...............-_...._........ :..... (If other than owner[ OR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 .. ......................... DATE ..... - D:•7, ..-........ ........... BUiLDING PERMIT ISSUED .......... ' ' _` .............•---•-------..---••-•>-�.�-w------y--•-"---':_�.:'-Y-='=-......:.------.....DATE ....................................... ADDITIONAL COMMENTS = ..---•......................:...................... ........................... .._. : Final Inspection .. by: ..._..�.... ::. �......,. .. ....... .. .....-Date-.: ...' . -� ti. _ SAN JOAQUIN :LOCAL''HEALTH, DISTRICT , F N 13 241_'AA Rav AM = 7/72 3,M y