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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate} Permit No. 73-` Q- --- - ----- ------------ ---- -- -]-'- This Permit Expires 1 Year From Date Issued I 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 main compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .----m r- -------/--------1 ------A-4------------ --------------=-------- - ---CENSUS TRACT --•------------------------ Owner's -------------- -.Owner's Name ---OX T---------------=-•---------- --------Phone ter_{ Address -- Xf�'AA�------------------------ ----------------------------------------- ------- --- City41AIDwe l------------------------------------------•----•------ Contractor's Name - /rCF ----.$ T? ----,S� ------------------------------.License #1-77gle-3----- Phone y / ,S�7 ------ Installation will serve: Residence X Apartment Housef] Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:.___ ----- Number of bedrooms -ol-____Garbage Grinder _/CSB Lot Size JA0 ,e9c* -__-____----__. Water Supply: Public System and name ----------------------------------------------------------- --------------------------------------------------Private. Character of soil to a depth of 3 feet: Sand'❑ Silt{] Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam;w 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,) IfPACKAGE TREATMENT SEPTIC TANK Size- 6-V Liquid Depth -y----------_--------- � Capacity/p?vQ--------- Type/_9P/_—',',_1Materlc!14 �,47frNo. Compartments OQ Distance to nearest: Well -6—?7--------------------------Foundation -AP-/---------- Prop. Line -_-_---__- LEACHING LINE ( No. of Lines ____ --------------.__ Length of each line----l0®_' g •� -- ---------- Total Len Length __ 114..---•- ---- ---- 'D'- Box S Type Filter Material I?Oe7k----Depth Filter Material _I_4--------------------- -. -----,....._ � i . Distance to nearest: Well -,TQ________-__ Foundation _/4_`______________ Property Line. ,.:.... dr 4 SEEPAGE PIT Depth ___ --.--_ Diameter _34-��__ Number 1--------------------- Rock Filled Yes No I❑ ri Water Table Depth -------3-00----------------------------Rock Size��---„�L-/----------- Distance to nearest: Well .,/ _____________ -----------------Foundation __fa.`--------- Prop. Line____.._____ C REPAIR/ADDITION(Prev.-Sanitation Permit# _------•--------------------- ------------ Date -------------------------------) � ) SepticTank (Specify Requirements) ----------------------------------------------------------------------• ----------'---------------------------------------------- DisposalField (Specify Requirements) ------------------------------•-------------------------------------------I-----------------------------------------------•----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------D --- d ad--- ---------------------------------------------- ------ -------------------------------- raw existingand required q 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 subject to Workman's Compensation laws of California.” Signed ------ ----------------------------- Owner BY ------ - Title --- (if other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -------- c°�Y---------------------------------------------------------- DATE --- 9"y- 71-1---------------- BUILDING PERMIT ISSUED_ DATE --------------------------------- -------------------------------------------------- - ADDITIONALCOMMENTS ----- --- ---------------------------------- ------------------------------------------------------------------------------------------- --------- - - --- y '' �` - ---- ----------------------------------------------------- ----- ---- -- ------------------ --- -------------- ----------------------------- - ULZ Final Inspection by: --- ----------------------------------------------------------------------------------------------.Datef � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M, ��