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r-FOR OFFICE USE: ------- -------- ---------- -----•-- ----------------- APPLICATION FOR SANITATION PERMIT7� (Complete in Triplicate) Permit No. 973------ ------- -------- ------- -----" This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATION ----------CENSUS TRACT -------------- _ •----•------ AddreOwner's Name ------ � _ 04S_0------------------------- ----- --------- ------ -- --------Phone ss -- g �?� _ lx?h� ---------------------- ----- Cit Contractor's Name ---------- _-ntf /-- — t = -_License # ��l�� Phone Installation will serve: Residence Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel Other - ----------------------------- Number of living units-------------- Number of bedrooms ------------Garbage Grinder -- --------- Lot Size Water Supply: Public System and name ---------------- Character of soil to a depth of-3 feet `_Sand 'Si]t❑- ' Gay' '0-- 'Peat-❑p `'Sdndy"Loam'❑-- Clay Loam;❑ Y- 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 TANK - / r � ] Size---- �`--��----�-- ------------- - Liquid Depth .----4�- ------ Capacity __.� [ ----- Type " tC Material__ ` �,�rzcT..ta� Na. Compartments Distance to nearest: Well ------" � / -- --- ----------- -----Foundation _-��--- ------- Prop. Line -- LEACHING LINE [ ] No. of Lines __""" Length of each /ine��Q_4_A90--- Total Length "" i',Q.•_----_--- i 'D' Box --- Type Filter MaterialIDepth Filter Material _."-� ------------------- f r Distance to nearest: Well - 0-0----_---- Foundation -------- Property Line ------------------- SEEPAGE --- ---- SEEPAGE PI7Depth --------------- _ -------------------- Diameter ---"-__ _-___ Number ------------ -------------- Rock Filled Yes ElNo i❑ WaterTable Depth ------------------------------------------------Rock Size Distance to nearest: Well ------------------------------------ Foundation -------------------- Prop. Line --""--- ------ REPAIR./ADDITION[Prev. Sanitation Permit# ------ --------------------------------- Date Septic Tank {Specify Requirements) ------------------------ Disposal ------------------.---Disposal Field (Specify Requirements) -----------------•--------------------- - i ------------------------ ---------------------- - - .:._ ------------------------- -------------------------------------------------------------------------------- - ----- (Draw existing and required addition on reverse side) -- dd --------------------------------------------------- 1 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: "1 certify that i the performance of the work for which this permit is issued, I shall not employ any person. in such manner as to beco s ject t Workman's Compensation laws of California." Signed -- -- ----- ------------ By -- ,�.GF � - - �—r_-- -----__ Owner BY ----------- --- ------------- - -- ---- --- ----- Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------- ----- - ------- BUILDING PERMIT ISSUED -----------------------""-- ------------------------------------- ---------- ----------- -- DATE - ------------------------------------------DATE --------------------------------- ADDITIONAL COMMENTS ------------------, - -- -------- - - -- --- --- --------------------------------------------------------------------------- - ---------------------- - - Final Inspection b p YDate ---- ' --------------------- ------------------------ -- ---- - SAN JOAQUIN LOCAL H- DISTRICT E. H. 9 1-'b8 Rev. 5M ��}�,