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i FGM OFFICE USE: j - APPLICATION FOR SANITATION PERMIT 73_/ii: "� _ .. Permit No. -- -------- - - ----- -- - ----- ---- --------------- -- ---- '` - e- (Complete in-Triplicate). ` - „ .�. .,.. _,�. 7-3 This Permit Expires I Year From Date Issued Date Issued 1-2: ". --------------------------------------------------- ----- _-. 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/.LOCATI N L =`,.0 ---- ,<aX�+� C /t'`-tet- -----CENSUS TRACT ----------------------- Owner's Name ___ _ - .------- --�4 - -- -- ---------- ---------------- Phone ------------------------------------ Address -----'`�_ 11-------�. L =�' - = itY C - / J - ---.License # __�lPq� Phonerc- '7b _ Contractor's Name,_____ _ _ _ _ ___ t - Installation will serve: �� Residence 20 Apartment House❑ Commercial :❑Trailer Court ',❑ A Motel ❑ Other -------------__ ------------------------------ y Number of living units:..__ '� Number of bedrooms !.Garbage Grinder -----� - _ Lot Size __.�- ---- ----------- Water'iSupply.. Public System and name ----------------------------------------`- - ---- ------------------------------------------------------------Private ❑ a Char6cter 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 [ ] SEPTIC TANKX Size_________ _.-_X_ " ./f ----- Liquid Depth ....../JX __.._______- Capacity �4 Type1:-5?4--------- MateriaNo. Compartments ---a---------•-•-•- Distance to nearest. Well i_*_--------------------------------Foundation ------L_d---------- Prop. Line __.._.�_l---.______ LEACHING LINE No. of Lines --------I------------- _Length of each line-------h1_A--------------- Total Length ,_-. ---------------- _ J 'D' Box _____I____ Tye Fi[ter Mat vial --------j�__`_r___Depth Filter Material ...-_.__ %'__s------------ -------------- Distance to neares#; Well ______ ----------- Foundation ------ -d________ Property Line f{�------ Number -_---------/--------- ----- Rock Filled Yes .� No C1SEEPAGE PIT [>J Depth -------9J �;Diame�e ___ - Water Table Depth ------ ------------------Rock Size ----- -- --•-------- t•Le.r7Distance to nearest: Well --------- ----—"'------------------Foundation ______ ____ Prop. Line ---X0--____-___-- REPAIR) DDlTlO Prev. Sanitation Permit# ------------------=-----------------------' ,Date _______________._________-_.------) i Septic Tank'(Specify,.Req`uirements) ------------------- ----------------------- ------------ -------- ------------------- ------ s - - L Disposd'fy°Field (Specify`Requirements) U �`'Q' - --------------- -7, r � ------------- ------------------------ + ------------ � �--' °4 ry------------------------------'------------------------- N ----------, p �0 --------- �-9}x'{ `^'` ---------'-------------------------------------------------------------------------- 3 (Draw ex--i- An-gl!!tcl 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 Sae.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 Workman's Compensation laws of California." Signed --------------------- ------------------------------- Owner BYf` -------------- -------------- Title ------ ---------------------------------------- (If other than owner) O DEPARTMENT USE ONLY ------------ APPLICATION ACCEPTED BY - --- - ----- -- - --------�------------------------------------------------------------- DATE _� = BUiLD.IN.G_PERMIT_.ISSUED:----, : ._ :- : .: : :----------------------------------- TE ------------------- -------------- ADDITIONAL CO MENT _ - ----------------------- --------------- --- --- ---- ----- ---------- ---- -- -- ` �-r��D' �7 J� ------------ ------ fQ-c. - -� b,6 - - - ---------------- ------------------------- - --- ' ---------------------------------------------- - LFinal Inspection Y: ----------------------- ------- - -- ------ -- ---------------------•-------------------- ------------Date - - �-` 7 ---- ---------- AQUI Ld�A-L HEALTH DISTRICT - E. H_ 9 1-'68 Rev. 5