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FOR OFFICE USE: t J� AR,LICATION SANITATION PERMIT ------------------------------------------------------ LA (Com ete in Triplicate) Permit No 7.3 _.____.. .. --- - -- --- --------------------- Date Issued �_/_: 3-*73 - This Permit Exp i s 1 Year From Date Issued ... Application is hereby made to the San Joaquin Local Heal District for a permit to construct and install the work herein described. This application is made in compliance with unty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION —ISA24RQ;_,_ ±�_1_'gL- . --------------t-PWjY_________.______.._____CENSUS TRACT ............ .. ._. ... .-- - Owner's Name mpf 4e�. 4 --Q 4/v"C-1 A Phone 3-- 0_ Address ___ __ ____ _ Q_ �S-__At 'Pa_ ' '----------- ------- -------- -- cityooeV000y72 cI ----------------------------------------- Contractor's ----- ------------------- --Contractor's Name ----- F A4-1-V--------------------------- ----------------------License .P2,15Q--- Phone"- ..---- Installation will serve: Residence [VApartment use,❑ Commercial ❑Trailer Court ❑ Motel Q Other --- ----------------------------- Number of living units:_______ Number a boom g r � ^ Garbage Grinder _____ Lot Size :___ ___-__ _.--____--------- ----- Water Supply: Public System and name _ -----------------•- ---------------------------------------------------------------------------------------------------------------------.Private [k Character of soil to a depth of 3 feet: Sand'[ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:'❑ Hardpan ❑ Adobe ❑ Fill Material------- If_yes,_aype _.._ , ;______ --= (Plot plan, showing size of lot, location of system in lation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit rtnittedpif pubic se ej is avai within 200 feet,) pp�� PACKAGE TREATMENT [ ] SEPTIC TANK[LI,�; Size-�---�-_-X� X��--- Liquid Depth _- v__. ---- °p Capacity J _ T __ MaterialCO/_��90�No. Compartments ...........:.... i /�/� Distance to nearest: Well �f_Q_________________________Foundation Q -_-___.._.__ Prop. Line/40.Y__... ._.__.._ 01 LEACHING LINE No. of Lines __ @ -- C ------- ---- gth of each line---<-0----- ---------- Total Length -?V.................... /f 'D' Box Y�S_ Type Filter M�° rialkfQ_�.i------Depth Filter Material 1-7-- ............................... J* ! o Distance to nearest: Well -46 _-------- Foundation -------------- Property Line A04P............. SEEPAGE PIT [ J Depth ---------------- -_ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit`# -------------------------------------------- Date --------------- Septic Tank (Specify Requirements) ----- ----- ----------------------------------------- Disposal Field (Specify Requirements) i _S /e---_ ' ACF �L�- �� - , �?-'- - ---- --- --- ---------- ------- --------------------- - -•----- ----------- (Drawe stigg and req�i'red-addition orrreverse 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: "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 -- --------- ----- ------- Titled_ /��E �, J�ff1� (If other than owner) FOR 9EPARTMENT USE ONLY n APPLICATION ACCEPTED BY ----------- ______ _-_______ _ DATE _-____ -----='-==�_-------------------------------------------------- � ----------------- BUILDINGPERMIT ISSUED ------------------------------------------------- ----------------------------------------- --------------DATE ------------------------------------------- ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------------------------------------------- ------- I------------------- -------------------------- --------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- FinalInspection by: ------------------------------ --------- --------------------------- ----------•------Date ----- -=- - SAN JOAQUIN LOCAL HEALTH DISTRICT r�E. H. 9 1-'68 Rev. 5M