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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Vb (Complete in Triplicate) Permit No. ..7....:.•-.-73 ....-- ----••••--.-•-••........................................ This Permit Expires 1 Year From Date Issued Dote Issued 57 .73 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/LOCATION ...... ��• - �-e- � � - -----f...... .... ......................CENSUS TRACT ....................... Owner's Nome ..........L ............................................................. Phone ' �1 . Address r /7 — V.��Alcense City � Contractor's Name .........1, .. ` ,.... # �l.l.. .../.. Phone Installation will serve: Residence 0 Apartment House 0 Commercial ❑Trailer Court 0 Motel ❑Other --- ---•••....... .......................... 7. � Number of living units:.... ....... Number of bedrooms ....�-'4 .Garbage Grinder ............ Lot Size .... Water Supply: Public System and name ....-•-•................•-•-•-•--...-•--------••--••-•-----......_---•---_._..._..............................Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type .....................I...... (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 208 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ j Size................................................ Liquid Depth .......................... Capacity .................... Type .................... Material...................... No. Compartments ...................... G Distance to nearest: Well ....................................Foundation ...................... Prop. line ...................... J LEACHING LINE (1(] No. of Lines ........./............. Length of each line...... 44'11!?.,Total Length..... 11 'D' Box ... ...... Type Filter Material ..... ......Depth Filter Material .....�Y............................... Distance to nearest: Well .... ..v......... Foundation .... .. .......... Property Line ....c-`�.............. � SEEPAGE PIT [ j Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No Q Water Table Depth ..................Rock Size Distance to nearest: Well ........................................Foundation .................... Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit#,............................................ Date ..................................) G Septic Tank (Specify Requirements) .......... . .--................................................ ...................._................................/ d Disposal Field (Specify Requirements) •• - .,. Jl= i.�. / ._. � ... ��.................................................-•••........................................ ---------------------------------------••••---...............---•----....•-•••...-•••-...••-••-....-•--•••.....•---••••-••-.....•••-•---•-•-••-•-•••••--•--•......---....._....._......................... (Draw existing and required dddition 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. Mom* owner or lien. 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 subject to Workman's Compensation laws of California." Signed ................................................. Owner By .. .. .�.. ..��.........•_--:: <.. ' - ...-..... Title ...,:__C... .. . ..!......... , ....... �! { (If other than ower) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........ ...... ...................................................... DATE ..."......-`_..�'_�,3..._._.... BUILDINGPERMIT ISSUED ............••...............•----••....:._............._......._............. DATE ........................................... ADDITIONAL COMMENTS .................................................................._... .••-•.....................................:................................•.__...............-.....••--••-•...........................................--••-.....................................-..... ...............................................................•-••-•-•....-•-.....................•..-•••-........................•••••---•......._.................................... ..........._ Final Inspection by: Lam... ..........._...........�........................................Date ... '�G..- (&............ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M 7/72 31P