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.FM OFFJCE USE: w ,_... .. APPLICATION FOR SANITATION PERMIT / .............. ... _.. Permit No. ...,�............... j ICamplete in Triplicate) _. .� .. }S/ 73 ... .................................................... This Permit Expires 1 Year From data]sued Date Issued .... ..•... 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 ...�.J�JC] f1VCp-�`------- - -- . .....CENSUS TRACT ..................... . . Owner's Name ....'n.,qk.+.H6.....E_...eRSP! LaY.............-....................... --------.........--- ---.--.Phone 46A._.h& f....... Address ..... .....:....... �-------------.--------------- .........-------•- . ---•--. City _... ��.(!4_ -..............-•-•-- . Contractor's Name .. _ hc------- -----------------------License # '`�... ..�3.._ Phone ._ _. .._ ... Installation will serve: Residence [Apartment House-❑ Commercial ❑Trailer Court ❑ j Motel E]Other --- -- - ----- -----•----_-------------- Number of living units:.. ...(..... Number of bedrooms -:?r�...Garbage Grinder .--. ..... . Lot Size .............. Water Supply: Public System and name ---&3&....U_ ----•---------------------------------------------------- Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat® Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe A 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,) PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size......................... ................ .. . Liquid Depth ........................... Capacity .. ..- - Type ------_-------- --- Material........ .... ....... No. Compartments -.----..---_---_- _ �J Distance to nearest: Well - - ------- --- -----------------Foundation ..... ........ ....... Prop. line ..................... LEACHING LINE C ] No. of Lines Length of each line ---- Total Length ............................ V 'D' Box .. .. Type Filter Material --------------------Depth Filter Material .... ............... -------------- Distance to nearest: Well ........................ Foundation Property. Line .-..............-_.-.-__ SEEPAGE PIT [ ] Depth . Diameter ....._...... ... Number . ..- ................ Rock Filled Yes ❑ No Water Table Depth ...----•-•--............. ......................Rock Size . -----•-•- ----•----- Distance to nearest: Well ........................................Foundation ............ .... Prop. line ........._..... ...... REPAIR/ADDITION(Prev. Sanitation Permit# -------- Date ........:.........................I Septic Tank (Specify Requirements) - . .,..._-------------------------------------------- ---�.......----------...---...._._.-_..-.--_....-----................. Disposal Field (Specify Requirements) -._...... "__.____... ' ------•-- . ............. . ... .........-. ............ ............. ......... ----------...... ...... ......---..................... (Drdw 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 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: "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 W rkman's Compensation laws of California." Signed Owner By .... - .-- Title . (If other than owner) ARTMENT USE ONLY APPLICATION ACCEPTED BY ... ........ .......... .... ......... DATE ... •---- BUILDING PERMIT ISSUED .-.. - - ...... DATE . . .................. ............. ADDITIONAL COMMENTS .. �, ------------------------- -- ------ -- ------------L.--- ------ ................. Final Inspection by: -- -- - - - ------- ......... ------._.---.............Date JO UIN LOCAL HEALTH DISTRICT 4 E. H. 13 24 1.'68 Rev_. 5M _ 7/72 34