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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 ------------------ ?.W ----------------------- (Complete in Triplicate) Permit No. .73 - --------------- ------------------------ .---.-_-----._-_---__.___-_---------.- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein F dP«ribecl. This application is made in compliance with County Ordinance No. 549 and existi g Rules and Regulations. JOB ADDRESS/LOCATION .`--- ---------- ___ ;�.- -- ----- tt �czdl--� .f .�CJC,--;=- -----CSUS TRACT Owner's Name ' /L�.- /2�1---- --- ----------------=--- ----Phone':----- ----- - ......._ --------------- ----- - ---------- Address ---------- Contractor's Name ---- Ub`* o 1 = License # 7/3 Phoned 4 / ..... Installation will serve: Residence artment House,0 Commercial ❑Trailer Court"'El .a- Motel ❑ Other -------- ----- --- ------------------------ f�4 Number of living units:________ _--Number of-bedrooms ---3-----Garbage Grinder-.._ Lot Size -./.7 , _, -------------------- '. lJ Water Supply: Public System and name ------------------------------------------ -------- ----------------------------------------------------------Private') Character of soil to a depth of 3 feet: Sand❑ Silt❑ ClayPeat ElSandy Loam.-E] Clay,Loam;❑ ti Hardpan ❑ Adobe ill Material Q--- If yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) `�i 1 PACKAGE TREATMENT [ SEPTIC TANK[ ze---_-_ j_-- Li uid .De th -_5-- q p o. Compartments _ . CapacifiY -, Type Material P = �j Distance to nearest: Well -__-__-_-�__1_________________Foundation Prop. Line LEACHING LINE LINE [J No. of Lines ----R-------------- Length of each line-----.�.�,45.......... Total Length-...,/�Q�......- 'D' Sox _ _.- Type Filter Material -_ O-4,4---_--Depth Filter Material ---m---------------------------------- /�l / _-___-_-i Property Line _ ._- Distance o nearest: Well __.__�`________-__-- Foundation ___1�_ __ --� _.-__..__... ,SEEPAGE PIT [ Depth ------ Diameter a ----- Number .-----.---j . _----------. Rock Filled Yes Leo 0Water Table Depth ---------6-{?---------------------------------Rock Size y Foundation - --�--/ ` } "/ s Distance to nearest: Well -------- --------------- - Prop. Line __ __..____.__...._ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------I------ Date --__-_-----__---------_---_-_-_-_-) Septic Tank (Specify Requirements) ` =---- ------- --- Disposal Field (Specify Requirements) ----------- --- ------------------------------------------------------------�-------------------------------------- F 1 f -------------------------------- ---------------------- ------------------------ -r ---------------------------------- ------------ ------------------------------------------I------------------------ ------------------------------- - -------------------------------------------------------- =------------------------------------------------------------------------------------------------------------------------------------------- 1 (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 Sari Joaquin County Ordinances, State Laws, and Rules and Regulations of the San .Joaquin Local Health District. Borne owner or licen- sed agents signature certifies the following: _` _ ' �' '_ N "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become subject to Workman's Compensation Icws of California." Signed --------------------- ------- ------ -----------'----------------------- -----------------= Owne BY -- -Title ------. --- ---- ------- ----------- ------------------------------- (if ------------- --------- (If of r th n owner): I FOV DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------ -- ----------J--------------------. DATE — ----- BUILDING PERMIT ISSUED --- ---- ----------------------------- -------------------------------- `------------------------------DATE ---------------------------------------i ADDITIONAL COMMENTS ----------------- 6 ------------------------------------------ - --) = - ------------------------------------\ - ------ --- --- ------------------- ---- FinalInspection by: --------------------------------------------------- -----------------------------.Date ------- �---------------- SAN-JOAQUIN LOCAL HEALTH DISTRICT C� E. H. 9 1-'68 Rev. 5M ''' i