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FOR OFFICE USE: APPLICATION FOR "SANITATION PERMIT r:.---.........s . .3.._. Permit No. 40 , lComplete in Triplicate) .......................... ------------ t Date 7 �73� ..............�._.�- This Permit Expires I Year From Date Issued .Issued 5 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 ........_.. .1-------- ----- ....... a ........Ci NSUS TRACT -..--------_---.-.------ �✓1<....._... --....Phone Owner's Name ...... .. ... ...�L-�!Y..?'��--------------------------------------- -•------- - Address . ( .... .. 0. _/ -L .:.... ----------.. City ............. Contractor's Name `-....License # Phone.��' Installation will serve: Residence XApartment House E] Commercial ❑Trailer Court ❑ Motel ❑Other ................. ........_ ------------ Number of living units:-....... Number of be rooms _ P2--.---Garbage Grinder .-' 1�Lot Size ---!4.� 1-=` �-••* -- w - a .° I Water Supply: Public System and name ._.._ .... ..___ --------------- --.......................... Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ . Sandy Loam [] Clay Loam ❑ Hardpan ❑ Adobe)( 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 ize.... Yf............. Liquid Depth.. •--_. . { J SEPTIC TANK ] SCIS �r �_._.- Capacity ._ Type ..............:..... Material...._.._.. .......__ No: Compartments ------_--...•. .......0 Distance to nearest: Well ..._..... ..... ..................Fovndot'on ......... ........_.- Prop.,.Line --_--------- LEACHING -_---- .--LEACHING LINE rV No. of Lines l Length o line. Total Length r ` D' Box .. _. Type Filter Mater i _. p Filter Material ... �� - De ............... i Distance to nearest: Well (l" .-...'.__:._ oundation �Q...�......... Property Line .. -...--.•..----• ; �sfE f {V" Depth .16 Diametere7e)6(4-e,Number - .. . Rock Filled Yes No UD SUM Water Table Depth ... ------- --------------Rock Size ....c;.2r. ......I--------- Distance to nearest: Well ------Foundation -A. �..-.--- Prop. Line A......... REPAIR/ADDITION(Prev. Sanitation Permit# --------....----------.....: ....... -- --- Date --------- ---_I � Septic Tank (Specify Requirements) ..... --------- ----- .- Disposal ,Field (Specify Requirements ................. .................... ......-...._... ----- ...------ ----- (Draw existing and required addition on reverse Fidel I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin f 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 net employ any person in such manner as to become subject to Workman's Compensation laws of California." " SignedOwner .... ....---'':... ... ....----- --- • ------------------ ------------ By ------- Title (If other than owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... DATE ._ . '. -� 7S.- ....:-. . .. DATE . BUILDING PERMIT ISSUED :... ,r,� ------------------ ..... .......... . . ..... . ................. ADDITIONAL COMMENTS ...... .. -' f O. - e Q � _ } •_ �_.• �-. 1,4- ,�_5 '4W .-------............................ .__.....---- - ._....--- -^R --1---- ".... _C�... ... ..------- ` .............................._..... ----- -...._.._....._.._... ........................................... --- -- ------- - •- ......... ----- I' Dare .._..3... --------.. Final Inspection by -•---- -_ - - ------ ----- --- ---------- • .... .--- SAN JDA UIN.,LOCAL. HEALTH DISTRICT r rr ...- .. CO ' 2 1_'AR Rpv_ SM 7/72 3'M