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i AOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 73-33� ................. .....................��;®�----- Permit No. ....._..._...------.. � {Complete in Triplicate} " ..............1...................... { Date Issued . ...... .....3 This Permit Expires 1 Year From Date Issued 4 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION = CENSUS .... �_- Phone ` Owner's Name ..C+i?.Z3 �eT.. .t..... ty --------- e oc.A-.... .... . ........................................ .... Ci - Address -- •-- -- I �N- Vie...........License # .........:.............. Phone Contractor's Name ...... t�.!9Y?.{�. :. :....__ �• F Installation will serve: Residence [ErApartment House-13 Commercial-E]Trailer Court 0 tt Motel [3 Other...........•............. ............ Number of living units:_.---r..... Number,of bedrooms ......Garbage Grinder _._.___.... lot Size ...5-P— - Water Supply: Public System and name .............. •--••.--•--•-------•-••-- •. -•----•. Private ❑ j Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] .. Peat C] Sandy Loam ❑ Clay loam ❑ Hardpan ❑ Adobe ET"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:publlc•sewer is available within 200 feet,) .r' PACKAGE TREATMENT [ ] SEPTIC TANKt) .. Size-_-_-•••.........................•••••---------- Liquid Depth ......._.---......--••-•--""� T .... ... Material.-......_.......::..._ No. Compartments ._......._........... r Capacity _............. Type .... ......... j Distance to nearest: Well ........... ..... ..._...Foundation ........._........... Prop. Line ............... LEACHING LINE [ ] No. of Lines ---------------- ------- Length of each line............................ Total Length ------._- .................. V Box TyP e`Filter Material Depth Filter Material .....................•---.• ' i Foundation Property Line -------_------------- I.: - Distance'to nearest: Well '---------------•- ❑ SEEPAGE PIT [ } Depth Diameter Number Rock Filled Yes ❑ No Water Table-Depth. ...--------z .......--••-.........Rock Size - i I ..Foundation Prop. Line � Distance to nearest: Well ....._.. ----•---••---------- ...................... l REPAIR/ADDITION(Prev. Sanitation Permit S# .. .... ..............I..-. Date ..........--------.-• -----••----) Septic Tank (Specify Requirements) --=----- •------... ................................ ............. ............./_4_:.................._................. Disposal Field (Specify Requirements} ---.---• _ .��.... r ''"'�.F�E`'�J---- -----T�-•--- -- ---- -- - k j -..... . ---•---- ...................................... (Draw existing and required addition on reverse side) I hereby certify that I have sprepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, dnd"Rule's and Regvlatiens of the San Joaquin local Health District. Home owner or liten- 4 sed agents signature certifies the following: . ( r "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 Wor man's Compensation laws of California." ' Signed ...........:... .... Owner .. B -- iNe (If other than owner) FOR DEPARTMENT USE ONLY T ' `....................................... -•-•------------- •--•--.........-•--.. DATE .._..�....._ .......Z . APPLICATION ACCEPTED BY .. .. . . DATE ...BUILDING PERMIT ISSUED .---___- `------------- •-• -----•_•--. ADDITIONAL COMMENTS ' _ ----------------------•----------- ... ...................................................... ............... .... .-•---•--•-----.-......•----- --•.....-.............._._.... ........ ....... ' ---------------------- ---- ._..... . ....... ....... ........ -----. -- •-- . .. .. ._ . ... Date � . ,� Final Inspection by: '�-1 ....:........... SAN..JOAQUIN_LOCAL HEALTH DISTRICT 7/723 .1