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FOR OFFICE USE. 1 j 1�7i APPLICATION FOR SANITATION PERMIT Permit No. 73-/d 7/ (Complete in Triplicate) --•--•-•- ......................................_....... This Permit Expires 1 Year From Date Issued Date Issued .fir ..7-7 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 *6�_�. 5 .......... ._..CENSUS TRACT .......................... Owner's Name ...............�N.f:)tz w. ---- /r. ................... ............................Mone Address ....... -........... City 57 :N.............................................. Q Contractor's Name .. . � !t.�. .- tgt2i2rS .......License #d- ..3- Phone Installation will serve: Residence (Apartment House'❑„Commercial []Trailer Court 0 Motel (:]Other /.:!<QEartG..l Number of living units:. _.l. _ Number of bedrooms _----Garbage Grinder Lot Size .... tc ...........� Water Supply: Public System and name . __...........___............. ........... . .... ..__..._.........------.........._......._..........Private It Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 00 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,) S PACKAGE TREATMENT [ ] SEPTIC TANK 1% Size...._..Io�c��-._ Liquid Depth ----'^ate. ........._� Capacity l��'� 7ype0' Material. - No. Compartments Distance to nearest: Well ..._._. ..............Foundation . .la... ..... Prop. tine .......... LEACHING LINE No. of Lines C� length of ach line _._.�-�..�. _ Total Length ..L.7t�..............V'+ 'D' Box .. f Type Filter Material .. .v�-.Depth Filter Material ....1.A{S. Distance to nearest: Well ..- ` �' --- Foundation /4�_~._... Property Line .��. ..........� SEEPAGE PIT Depth /0” Diameter "X ... Number .._� ------ _- Rock Filled Yes ( No C]"- Water Table Depth ._ -...--.............................Rock Size ..... .. .. ........ � *�_ Distance to nearest: Well ... ................... Foundation --- Prop. Line ...�� .............? REPAIR/ADDITION(Prev. Sanitation Permit# -------- _.. _...... ............ -----_- Date ........-........_.............---) Septic Tank (Specify Requirements) . . ...... .. .................. ............_..-..----- ........... ----- --...,_.............. .-----....-----......_.i.._.... Disposal Field (Specify Requirements) ------------------- -- ---•-•---- --- -- .. . _. ...... ---- .. (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 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, 1 shall not employ any person In such manner as to become subject to Workmo 's Compensation laws of California." Signed . Owner By . . . . Title _... jlh� (If other than owner) F R DEPART SE ON Y APPLICATION ACCEPTED BY _.. _ . DATE . ///'Z� y?�'.. ........... BUILDING PERMIT ISSUED .. . __... .. . ...-___. -_ .. DATE . ........ .... . __... ........ ADDITIONAL COMMENTS - _. ------ ------------------------------ Final Inspection by: . J . t. ......... Date .._. . . : ::: : :.::- ::::::::: SAN JOAQUIN LOCAL HEALTH DISTRICT 13 241-'68 Rev. 7/723 ,14