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FOR OFFICE USE: � Il- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .73:5/P�. ........... ............................................. C-/i -73 ...................................................... This Permit Expires 1 Year From Date Issued 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: 9 � .s�� _ JOB ADDRESS/LOCATION ...1.............._....--,--.��......��P.1.�.�....,...-.........-........-...................CENSUS TRACT Owner's Name^. .. .0 f,,,`.,lel`"............................................ ............. ................Phone .................................... -C1•/��' .....�' �/... .. . ��.... City � .. .......Address ......S. ...... . . Contractor's Name ...........r1iGa�.. (de l a '...............................License 471.0-S3?... Phon0q_� . 6/z... Installation will serve: Residence (,"'Apartment House❑ Commercial❑Trailer Court 0 Motel ❑Other ............................................ Number of living units:.--./.... Number of bedrooms _.. - ...Garbage Grinder .*e. Lot Size t?.X.. .��'................ Water Supply: Public System and name ... (l ,l/ AR1'..... . -r:.......................Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeX 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,) LV PACKAGE TREATMENT ( ] SEPTIC TANK Size................................................ Liquid Depth .......................... N Capatity .................... Type ............... Material...................... No. Compartments ...................... Distance to nearest: Well .-,................ ..Foundation Prop. Line LEACHING LINE PQ No. of Lines ........................ Length of each line............................. Total Length ............................ 'D' Box............. Type Filter Material Depth Filter Material Distance t"earest: Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT R Depth ....!......_.__.__. Diameter ................ Number ............................ Rock Filled Yes ❑ No Q Water T?ble Depth .............Rock Size Distance to nearest: Well ........................................Foundation .... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) Septic Tank (Specify Requirements) ................... 1....._._...._...............�........�. ..............._............._.....�...._... Disposal Field (Specify Requirements) .... .y ..... ! _�� .... _ .. `'`... W....../.-e-?....,G',Xlwr�'f ,�......._. _......_.. ' .........................................................................•-----..............---------..........---....._......I.................. -- ..........................................................................................................._......------...................................................................._........... (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 Son Joaquin County Ordinances, State taws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: i "1 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 to Workman's Compensation laws of California." Signed ......................... ..................... Owner By ........ ......................... ......�.. .............. litle ....L." � 1`�.............................. (If other an owner) FOR Dk?MTMENT USE ONLY APPLICATION ACCEPTED BY ..._. ............................... DATE ....... I. BUILDINGPERMIT ISSUED ............ ..... . ..................................... .. ...............................DATE ......................... ADDITIONAL COMMENTS ..... ......... ........ t�. � :. . :.::::::: ::::::::::::.:: :: :::::: ::::::::.::: :::: ` ... �......... .. .. ............................................................ .....................6........:::._......::: :..... ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.....::::::::.. Final Inspection by: ..... ...........................................................................Date . 7/j.. -�.. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241.'68 Rev. 5M 7/72 3 M