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FOR OFFICE USE: � 7-7APPLICATION FOR SANITATION PERMIT y, 1 ----------- -------------------------- (Complete in Triplicate) Permit No. __.73 __f�_ _ ---------=---- --------------------------------- = ^ ,=' _---- This Permit Expires 1 Year From Date Issued Date Issued ----------- Applicationris 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: .� t +: f: t.s:- 7, i fid kj W " i�'Fjti. � . - --------- ---: �JOB ADDRESS/LOCAT ON kI ------- �_-__CENSUS TRACT Ower's _ : .. ---------------------------------------------P hone ------------------------------•-•-•- Address l x t✓ D-- ------- . .City --- �IYV = Contractor's Name --- ----- —-=--------------------------- ------------------License # ----- -----------------^,_ Phone ------------------------------ Installation will serve: Residence ❑Apartment House❑iCommerc+al ❑Trailer "^ �;� .N + * :� _..�-.�_�Y.�...�...� ,Motel ❑-Other-=__�__�---=-�_.__::_--:_---_-�-/... -- ----�•-----.___,..,,.,_._.....�.....�.__.��_ .T Number of living units:------ Number of bedrooms 7Z=____Garbage Grinder 01_� Lot Size __4CR G . .-________ + _______Private Water Supply: Public System and name -------:-A �` ,3 = 4 1- � Character of soil to a depth of 3 feet: Sand' _ Silt E] Clay ❑ Peat❑,. Sandy Loam ❑ Clay Loam:❑ I i Hardpan [a Adobe ❑ Fill Material _-_________ If yes,type ____________________________ (Plot,_p.lan,-_showing-size.of lot,—iOGdtion of-.system_-int reldt+on_to,we'llts��- iltdings, etc; must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK' Size--' 57>(--/ Liquid Depth,___ _ `--------..__ AA Capacity 'lM------- Type �aUPvE DMateriai__�� -�7""-?To Compartments ____ �._____ Distance to nearest: Well _.__ _"'r"-":_____--..Foundation ____�L!__ �__ Prop. Line .. ___'"~.___ LEACHING LINE , . o. of Lines ----- LEACHING Length of each line------- f.. Total Length •� pBox4` Type Filter Material _I-;QP�,Depth Filter fMaterial ----{/ -----------.i_____________ ' Distance to nearest: Well ___ -t='Foundation Property Line -__ -777�!i....... SEEPAGE PIT [ ] Depth ---------- ------ Diameter ---------------- Number ---- ----------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------- --------------------------------------Rock Size ---------------------------••--- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----___........ REPAIR/ADDITION(Prev. Sanitation Permit# ------____---------------------------------- Date ----------------------..__________) Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------------------:-------------•..--,---------------- ------•---- Disposal Field (Specify Requirements) ---- p1�----� �� ---- - ---------------- - I C�- R - �OMA�_-.----�--�2�}-v F ------------------------------- --- --------------------- ------------------------------------------------ ------ f \.A51-AtA Cj(Draw�existing;anal„required addition on reverse side) E 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 liven- sed agents signature certifies the following: "I,,certify hat in the performance of the work for which this permit is issued, I shall not employ any person in such manner as'to b me subjec. t or 's Comp nsation laws of California.” -1s Signe Owner BYE -0! Title + (If other than owner) I FOR DEPARTMENT USE ONLY _ �-s if -�- ~��` _ APPLICATION ACCEPTED BY E C ......------� ------------.---------------------------- DATE z ` 7 BUILDING PERMIT ISSUED -------------- f ~^."- ---------DATE ------------- ------- - --- -- ADDITIONAL COMMENTS ___ --`" --- -------------�"` -------------- ------------ ��:,f � . . ----------------------------- ----------------------- - -------------------------------------------- ----------------- - _.-. y ----------------•- ------------------------ ----------------------- ---------------------- - ---------- --------------------------- -------------------------- ----- -V_ i, ,� Finallnsp _ `' _.- Date SAN JOAQUIN LOCAL HEALTH DISTRICT l E. H. 9 1-'68 Rev. 5M