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FOR OFFICE USE: APPLICATI&Nf FOR SANITATION PERMIT 3—�ifG ........-•---------- PermitNa. ...7..... .... .... jA (Complete in Triplicate) s Date Issued ..5..:...: 73 .......................N, 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 No. 544 and existing Rules and Regulations: :3C< ....CENSUS TRACT ..........:. JOB ADDRESS/LOCAT ON ..:.7. _.. ;. ��. '.................................................... ..._....._.... Owner's Name 1CfirFlr� �:.._ U 1` ............................................... one .. YP .. ` g........... Address ... ........... .................--•................................................. City -----------•.................---•......t.....--•-•--------.......---......:. Contractor's Name ...._._... f3 !�ls g ��'~ .....License # :....................... Phone ' -------------------- . Installation will serve: Residence 0 Apartment House'❑Commercial ❑Trailer Court 0 fi j Motel ❑Other -------------------------------------------- r Number of living units—_I.- Number of bedrooms __.. Garbage Grinder ------------ Lot Size ...... r -- Water Supply: Public Systemandname .............. ------__..___-_._..........................................Private ❑ Character of soil to a depth of 3 feet: Sand n Silt❑ Clay El Peat[I Sandy Loam ❑ Clay Loam ❑ I� Hardpan ❑ Adobe ❑ Fill Material ----- If yes,type ____________________________ d (Plot plan, showing size of `lot, location of'system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (Noseptic tank or-seepage pit,permitted if public,sewer is available within 200 feet,) PACKAGE TREATMENT [ j i� SEPTIC TANK( j Size------------------------------------------------ Liquid Depth .......................... Capacity ................•--- Type ---------•-... Mti ...:. aeral._..... ....................... .----....-•---- No. Compartments .�I00 Distance to nearest: Well ....................................Foundation ...................... Prop. Line ......................� LEACHING LINE [ j No.11of Linesti'------------------------ Length of each line.------------............... Total Length ...._...............__-_---- 'D' Box .........!'--- Type Filter Material \...... Depth Filter Material .................:... ante`-to i estnearest: Well ......................... Foundation ........ ......... Property Line ---------..----...... -r ,_. ,, w f SEEPAGE PIT [ ] Depth --------_......... Diameter ................ Number ............................ Rock Filled Yes [3- No ❑ Water Table Depth ---•--•-• ..................Rock Size-------.......................... Distance to nearest: Well ----___-____ ..... ..__._.....Foundation Prop. Line ...................... IA REPAIR/ADiDITION(Prev. Sanitation Permit 0 __ Date .................................. Ifi Y{ Pt (Specify Requirements) ... ............ ................................ - .... . o p "x DisAosal� Field (Specify Requirementsl ---------._ I .. p. i ............ _. ...... - •-----....-•---------------••----------'.... ------------------- ---_. ---------••----_ ....... ............................ ........................... ••---•-----..._.........- .......... . ........................r........................ : ............ ........................... ...............�._. (Draw existing and required addition on reverse side) I hereby certify that 1 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 iicen- sed agents signature certifies the fallowing: "I certify that:in the performance of t-6 worn For which this'permit is issued, i shall not employ any person in such manner as to become subject-to Woifkman's Compensation lows-cif ICalifornia." a Signed .............. .� _. Owner -------•----•• title .__ ...... ......................:.................... l (If other than owner ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........ .. ............................ DATE ...._.. ... .....3.._._.:... BUILDING PERMIT ISSUED -,...•............. . .... . ----•-............. ----......... DATE _... ::...._.. l ADDITIONAL COMMENTS .. ....................................... - ......................._.... - , .... _ .. ............. ------------------------ -- --- ----•-----••-•--•--•-... _......-.-....---.....----------•.... ....... _............ •---...... i Final Inspection by: ........................•- Date .... .._ .._ SAN.JOAQUIN LOCAL HEALTH DISTRICT I F N 13 24 1.'68 Rev. 5M 7/723 ,