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,-,;-FOR OFFICE USE: -,� APPLICATION FOR SANITATION PERMIT ` AJ L . 'k._.......... 0�....._....................�1 Permit No. ..73-....-•-..._. 1 (Complete in Triplicate) ...................Z�...J 7 Date Issued .-7.. °.�.• 3 /- _ �e-_ -'" This Permit Expires 1 Year From Date Issued Application hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described, This application is made inf—tortipliance'wi#h County Ordinance No. 549 and existing Rules and Regulations: .........CENSUS TRACT .................... JOB ADDRESS/LOCATION a :..... 1.�� ,�.... '.� S��l... <.-..._.. .. . I . � . e ...._..... "Y _ .......... ..-PhoneAddress 1.......... ---•-•................••-..--- Contractor's Name .._.... �-� !� License # -- Phone �:., ...fes_;_.....------ ------ " Installation will serve: Residence$Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ...................................... 4 Z. - Number of living units:.../ ;_ Number of bedrooms ...--Garbage Grinder l -- Lot Size . •--••••• Water Supply: Public System-and-name ......................................-------- -- Private, Character of soil too depth of 3 feet:`-- •Sand-13—~Silt C1< Giay,❑ Peat❑ Sandy loam ❑ Clay Loam # Y e -------•--•-------- •------- s ' Hardpan ❑ Adobe Fill Material ........_..i 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 pVblic•sewer is-available within 200 feet,) 1+ _ Y PACKAGE TREATMENT' [ ] SEPTIC TANK-T ] 5ixs-- :--- _ ....................•--..__.... Liquid Depth .................._...__--P - - .ti Type Material ............... No. Compartments . ......................•p Capacity ..__....----• ...... Material ..................... r e ---- ----_-••--- t �s�,' Distance to nearest: Wellz__ Foundation . op. Lin LEACHING LINE [i] No. of Lines ------tib=-------------, Length of each line.-----_--- ...:.------ Total Length •..---•-•--•.._........._._.t 'D' Box _ Type Filter Material .Depth Fiiter Material ........................................... t ,"- ' 4 i Distance to nearest: Well ................. . Foundation _....•.. Property Line •-•--•--..... N . Number ..__ ..__. Rock Filled Yes ❑ No CIS SEEPAGE PIT [ j Depth Diameter .....:. `..`.:. J "Water Table Depth ...::.............Rock Size _--J-1;`:...-----..._. .... I . Distance to nearest: Well ...._Foundation '' Prop. Line _.......___•__..-..-.. _ l ••-•..............................' . Date '.�`.......................'..--•) o REPAIR/ADDITION(Prev. Sanitation Permit# .-••.._•----•----•---•-- •---•-.... 1 .� e7............ .. .. . Septic Tank (Specify Requirements) ---------------- f -•-- ' � : Disposal Field (Specify-.Requirements) �' q ellz .}_ F, •t 1 )Draw existing and required addition on reverse side} 1 hereby certify that I�have prepared this application, and that that work will be done in accordance with San Joaquin County Ordinancei; State Laws, and Rul z-.and Regulaiions of the f f Joaquin Local Health District. Home owner or licen- sed agents signatuirii 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 Califofrnia." l lSigned .... .. ... •---- :............... Owner litle By .. i (if er than owner , REP ENT USE ONLY hY APPLICATION ACCEPTED BY f. ..................._ ...... ._ ._. ..•..... - �� DATE . BUILDING PERMIT-1 SSUED _ _. _. :... .............. ADDITIONAL COMMENTS ` .......... !_......:' - •.._......--••....................... ..:........ ..•--.........._........-- -•• r�_ --------------•-- _----_- -------- --- ......... ' t .� Final Inspection ' �a Date ........ j �wSAN .JOAQUIN LOCAL HEALTH DISTRICT �- ,. 11 24 , ice e_., cAA -— —