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FOR OFFICEUSE:. APPLICATION FOR SANITATION PERMIT ~ (Complete in Triplicate) Permit No. __73---- ---------------- This Permit Expires ] Year From Date Issued Date Issued ...7� --- 7J 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 Re ulations: JOB ADDRESS/LOCATION -----f��_S.Z--------- �' r��1+< c -------Rc3--------------CENSUS TRACT ___�_ Owner's Name r _ 7 -�c---- t----- a `^` e - Phone .--g.3 Address ------ ------------- ----, (fes-------- - City --------- --�-- Contractor's Name -------------------- --------License # __2 5 {0--- Phone ---6�U` Installation will serve: Residence;,Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ---------"- ----------------------------- Number of living units:.________ Number of bedrooms __sr_____.Garba a Grinder _Y-45. Lot Size ___ ___�- 4-!Z g / -----l4-C---- ----------- 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 permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKSize / !r [� ---- ��--�------ -�--S------------ Liquid Depth --- Y-_----•------- --- Capacity ______ Type 0_�__7:SA'lyaterial_��_ "4106------- No. Compartments ------- .--------t✓ Distance to nearest: Well ----------g.5".............. ----Foundation -------/p--------- Prop. Line ------ZQ._----- -- Ul LEACHING LINE � No. of Lines __ .�_-_________ Length of each line_______� �_ ------ Total Length __________,__ r 'D' Box / -� Type Filter Material ��—__-__Depth Filter Material :__-_____1/, `l ` Distance to nearest: Well _____1pf_?_ ______ Foundation -------- S�__y______ Property Line ______.C96"__--_"- SEEPAGE PIT �(� Depth ____________________ Diameter ____ __________ Number2— Water Rock Filled Yes E] No 0 P, Water Table Depth " -----�--`��--------- -----------------------Rock Size ---------f,��------------- Distance to nearest: Well ----------------------------- -----------Foundation -------------------- Prop. Line -------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------ bate ______________________ ) ----- --------- 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: "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 su iect to Workman's Com sation laws of California." Signed ��- Owner By ---- --------- ----- -�1_ ---------------------------------- ------------ Title ------------------------ ------------------------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY r------------ -_ --------. DATE _.____ �✓ - BUILDING PERMIT ISSUED -- ADDITIONAL COMMENTS ------ DATE _.. ------ -- ------------ ------------- -- - -- - - ---- -- -- -- Final ------ tF ----------- - ---------- T -- ------------- -- ---- ------ ate -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M