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FOR OFFICE USE: 10 APPLICATION FOR-SANITATION PERMIT �o�fy... Permit No. ..73..... _.. ---.....I.............. .. ..... (Complete In Triplicate) .............•...._._.... pate Issued . '!�1-73.. _ '"- :_ 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 compliance.with ,County-Ordinance..Na..'549 and existing Rules and Regulations- JOB ADDRESS/LOCATION . , . _. .. .1'f/? s /C .......................... NSl,�5 TRACT ................... _ . ..............._ ..• _... _ -�- - Phone Ownerrs Name W� . !/� ' �I'I. ..................... ---=- ............. Address ..__. � ...................................................... City �. ' •--.. ..---.._._ y .. Contractor's Name :.__ lr � _ � ✓ --•...........License # . Phone Installation will serve: Residence Apartment House❑ Commercial Trailer Court Motel ❑Other ................................. ...... Number of living units:..- ..... Number of_.bedrooms,__. • Garbage-Grinder / _ Lot Size _±; L - r i --•••-••••• Water Supply: Public System and name _ _�f�ift"--�°1�,ti•s --=- l� �� Private [3 I Character of soil to a�depth of 3 feet: Sand❑ Silt❑ Clay ❑ ..Peat❑ 5andy Loam ❑ Clay Loam ❑ T Hardpan ❑ Adobe Fill Material _...... ......If yes,type (Plot plan, showing size of lot, location,ofsystem 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,) � SEPTIC TANK S'ze._ .....----•---..:__: liquid Qepth .. ........ PACKAGE TREATMENT ( -- Capacity f -------- Type Material. lid :-_--- No. Compartments .2............... _> ;: -�--- s Foundation _� Pro Line . _.•...... Distance to. nearest: Well ._.... _. •--------. p' / r ..... length of ea( line._..- 49_...-.-•---._. Total Length ..fes ......... 1_EACHING LINE No. of lines ....... ........... �ie ��/" I D' :Box Type Filter Material !`L-�� '� Depth Filter Material Z Distance to'neorest: .Well ........... Foundation _.Xe............ Property Line .... ...:.............. SEEPAGE PIT Depth ...s.as .- Diameter .X;? =dumber � �•--__ Rock Filled Yes No ...._.. Water Table Depth ....... .�... ... ....Rock Size XK!'..s .. - • r . Distance to nearest: Well ...Foundation .... Pro Prop. Line • •-----••••• - (, REPAIR/ADDITION Prev. Sanitation Permit# ........................................... Date .................................. Septic Tank (Specify Requirements) .................. ......................................-.................................-................. Disposal Field (Specify Requirements) ................... ----------------- . .._......_......-----------••--------...--•------......--------...----••--._.........._..........._...._... - ' .._.....---- .. ........... ----................................. .- ...._...:y:__..._..._-------------------------_ -•---••----•----•-•---.....--•---.........•••---._.....__..._.._......_._.. . �— (Draw existing, and required addition on reverse side) I hereby certify that-I,Gave 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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: - - r "I certify that in the performance of the work for which this permit is lssued; l shall not employ any person in such manner E as to become subject to Workman's Compensation laws of California."- Signed _ ..------ �-,. . Owner r .-----------•-------- Title .. ,1��`�-. BY ........ _----------- - ------ . �` r (Ifo r t an owner) TMENT USE ONLY 4 DATE _.,_� APPLICATION ACCEPTED BY w / ..._•.••. BUILDING PERMIT ISSUED'.. :_" ...'" DATE . ........... ADD T NA COMMEN . .... ... ......... _. Date Final inspection by: -1 r�` JO IN. LOCAL HEALTH DISTRICT •".'" 7172.3... 4 c u 13 24 1--Aa Rwv 5M - -