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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - Permit No. .73_--------- ------------ l�__ - (Complete in Triplicate) --------------------------------------------------------- --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _1_-13---- . 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: r'� i 9 _ --------- '��= r----IP--------- JOB ADDRESS/LOCATION .-------_-_A_r _.._--____-, ----------------------CENSUS TRACT -------------------------- Owner's Name ......... .ee- G ------- G? ' d' -- ------.Phone --------------------------------- Address --------- -- -- l �f �3 � 1 /' r City 7L1G/(�TDij.�------------------------- -_._ -- Contractor's Name ------A-4*114----- - --------------------------------------License # - / fir _ Phone Installation will serve: Residence KApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------ Number of living units:____}_____ Number of bedrooms ______Garbage Grinder ------------ Lot Size ----�) ----- ____________________ Water Supply: Public System and name ---------------------------------•-----------------------------------------------------------------------------Private DR Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam N' Gay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ____________________________ `n (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) vi NEW INSTALLATION: fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK [ J Size----cd_ _ _X�__Jr"�C________ Liquid Depth -------------------------- Capacity _.________ ._Capacity0------- Type )9,94;r6 W[ Material---------------------- No. Compartments ____�__ �} Distance to nearest: Well ------- -------------------------Foundation ------------- Prop. Line ---------------------- LEACHING LINE [ ] No. of Lines 3- Length of each line----V'4_r_-____.__-___ Total Length ___a--- �_ ......___. 'D' Box ------ Type Filter Material _ s1'a4! Depth Filter Materia! --__ _ ______---------________________ , Distance to nearest: Well ------0-- --------- Foundation __/,0 ......-__ Property Line _____________ SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No C7 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ----------------- -- -----------------------------------------------------------•---------------------------- Disposal Field (Specify Requirements) -------------- - -------------------------- -----------------------:-------------------------------------------------- --------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ---------- ---------------------------------------------------- ---- ---- ---- (Draw 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: Y "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 ty Wor an's Compensation laws of California." Signed ------40G- �- r----------------------------------------- Owner BY ---------------------------------------- -- -------------------------------------------------------- Title - ---- ----- (If other than owner) F R PARTMENT USE ONLY APPLICATION ACCEPTED BY ------------- ^- ° �-'— ----------_ DATE ------ -- /`�:-�` --------- ------------------------------------------------------------------ BUILDING PERMIT ISSUED --------------------------------------------------------------------------------- DAT£ ------------------------------------------ ADDITIONAL COMMENTS ___3+�� 23____� -�_� -- -r' - '_' �--� ,------- --------=--------------------------•---------------- ..---------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- ---------------- ! ---------- ------=------- Final Inspection by: _____________ l_ 1 -_ - ----------------------------•---------------------------------------------------Date --------------�-----.�3_ -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M