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FOR OFFICE USE: APPLICATION FOR�SANITATION PERMIT 111690 Permit No. ....7-3.-7t�/� ......... ................. {Complete in Triplicate} ..................... ......-........................... Date Issued This Permit Expires 1 Year From 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 complian with County Ordinance No. 549 and existing Rules and Regulations: 2 --..,-....CENSUS TRACT .:............:....... .... JOB ADDRESS/LOCATION `� 1�......................•--•-• Owner's Name r: .......:...................... ...............Phone ��.s��5� 77 � ....... City /e Address ._.h �_ .---. .6 ... D . K� . Sr'3 . �• 7�RR.F2------- -------- .. .........License r... }a Phone . i Contractor's Name .................:........... Installation will serve: Residence (Apartment Douse 0 Commercial ❑Trailer Court 0 _ Number of ❑drooms -_----• --..Garbl --- _�_•••___• •-- Motel Other ------_-------------- Nvmber of living units,.__._[.._... � age Grinder ............ Lot Size .................... .. `~ F Water Supply: Public System and name .._.__ ... Private ❑ Character of soil to a depth of 3 feet: Sand)V -Silt[:] Clay ❑ Peat[] Sandy loam {] Clay Loam C3j r Hardpan ❑ Adobe 0 Fill Materia! -"=T---.-.. 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 ifspublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------ -.............-......................... Liquid Depth _.................. Capacity --------------•-••-- Type .................... Material...................... No. Compartments ................. v Distance to nearest: Well' -------------------- - -•---=._Foundation ..--_-...- ----------- Prop. Line ...................... a LEACHING LINE [ ] No. of Lines ------------------------ Length of each .line..._......................... Total Length ..-____---.--... ........... I •D' Box ------------ Type Filter Material .........Depth Filter Material .....:-•.................................... # 5 Distance to nearest: Well ...................... . Foundation ._. ............... Property Line ....-..:-------........_ SEEPAGE PIT [ j Depth 1 * Diameter .............f.. Number --------._.... ............. Rack Filled Yes ❑ No.C] -------,.-•-- --- f ' Water Table Depth Rork Size ................................ c •••---•---•- Distance to nearest: Well Foundation .................... Prop. Line _....---------.......- 3 REPAIR/ADDITION(Prev. Sanitation Permit # ..... •- ...... Date ..........-••--••-•----------•-••-1 Septic Tank (Specify Requirements) ...................__:......---�--...-....--•#••••r .............. =- •--........__ ........ A Disposal Field- (Specify Requirements) ----• 1�3_---- �` ` cA,...� ----- s....... . == z ° - .............................. ...-- f---- •-- -... ....... ................... . ----------------------....................... _------------ I (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and thaC 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 i "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 ject to Wo an's Compensation laws of California." .._.....-•--•-----•------ ----------•----•--•------------•-- Owner 5:gned - , r .------.... ................... ._:....... . i t —By ..-----•-- ... ._. ......... :.............. Tit e ' If other an owner} 's•: FOR DEPARTMENT USE -ONLY APPLICATION ACCEPTED BY ------••--- :-.__.. ......... ..............-•••------........-----..._._......-•- ...... DATE .. BUILDING PERMIT ISSUED ............................. f'' DATE .............. .............. ............ ADDITIONAL COMMENTS ................ .............. . .......... ............................................................••......-------...-----.......------_._._-•.----•-- -___--- ......................... .................................................................................................................... ----- --_----•__......._---......._.. -.-._-_-_................................... __ _ _ __...-.--.. ...................1-•-------- ...... ....Date .......... ........... ....... SAN JOAQUIN LOCAL' HEALTH DISTRICT _ QP 7/72 3-M ,