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i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -' ,�t w Permit No. .73_�A------- 3 i (Complete in Triplicate) This Permit Expires 1 Year From bate Issued Date Issued -_....__--- _ ------- ----------- ---------------------------------------A ` Application is hereby made to the San Joaquin Local Health District for a per 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 ---r 7/ - _ .a ---------------------CENSUS TRACT ----------------------_ Owner's Name -- -- -- �. _ -----=-------------------Phone. `1 7_'¢5` - L-7_ L1L0 c. �z'1c /�7 Address -- -------------- 7 f -------- -- --V_ -------- - city --`----- - ----------------------- ------- ---- ---- --- ------- --------------- 1 - - n License # - ---- Phonez1p��&-QyZ.---- Contractor's Name ----- --- ---------------- �{�`�` - = Installation will serve: Residence;,Apartment House'❑ Commercial ❑Trailer Court i❑ Mote! ❑Other -- --------------------------------------- Number of living units: _t-)-- Number of - edroommmsj -_Garrrbage Grinder ------------ Lot Size _ __ - ---------------------- Water -------------•---- 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 permifi ed if public sewer is available within 200 feet,) l( PACKAGE TREATMENT [ I SEPTIC TANK�Cj, Size_4'* ___` --5-------------- Liquid Depth _-________-.----- �( Capacity/wo Type Materia ___ _ _ __ _ No. Compartments ___-.7�__ --_ it r r Distance to nearest: Well _____�]D--------------- -----Foundation ._�f>�___________ Prop. Line ____ _O_..______ � LEACHING LINE [ ] No. of Lines ��;_•___._.__ Length of each line__ ------ Total Length ---/7a ' ] E( 'D' Box __. _ Type Filter Material/-- k-OC�._Depth Filter Material ____ _ ---------------------�--------- /�` f Distance to nearest: Well ---4?0------------- Foundation JW--------------- Property Line S ............ —�'1 3 cr Rock Filled Yes No10 SEEPAGE PIT [ i Depth ' -__ Diameter __-_�_________ Number - C -- ----1 --t` �. Water Table Depth ----------- UP-------- -----------------Rock Size ---- �------------- r Z� `" Foundation _ - ------- Prop. Line _: ._____ Distance to nearest: Well ---_____-L ----- REPAIR/ADDITION(Prev. Sanitation Permit# ------ Date __________________________________) Septic Tank (Specify Requirements) ---- -- --- ---------------- -- - ----------------------------------------- -----------------------_-- Disposal Field (Specify Requirements) --- ---------------------------------------------------------------------- f ----------------------------------------------------------------------------------------------------4ju--------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 o.f the San Joaquin Local Health.District. Home owner or licen- sed agents signature certifies the following: "I certify that in a erformance the work for which this permit is issued, I shall not employ any person in such manner as to becomes ble to W(fkma '` Co p n3a ' aws of California." Signed --- ---- -- --- - - -- � -p- n - - ---- ------. �. wner ------ - —-- - - itle -------�---------------------------------- ------ other than ow er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -------------------- . DATE BUILDINGPERMIT ISSUED -------------------------------- ------------------------ --------------DATE ------------ ----------------------------- ADDITIONAL CO MENTS --------- ----- --------- - ----------- --t Y� /_:_ � U - 5'd r�' ��-----=• - --- - ------------ - ----------------------------------- ----------- i - - --------------------------- --------- Final Inspection by: Date =7 AN JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 1-'68 Rev. 5M