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FOR OFFICE USE: ;. APPLICATION FOR SANITATION PERMIT _..... ............... .2e.`od........... 73.-3,-3 IE (Complete in Triplicate) Permit No. ...... ............. ........................................ .. ..... S-7 73 --- This Permit Expires I 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 ADDRESS/LOCATION :..L. . _.. �� ,....... ..............CENSUS TRACT. ., �r _........_ -. . _ �7 Owner's Name .........i.........�r-�---�--�... _tet. Lr....--•• . ---... _.._.Phone l . �yj Jam/} ---• ------ •----•-•--•--._ ............... .......... , Address �! _ 3. .......1.:_LILL_r_.. City ..................................:.._............................. Contractor's Name ....:`.......... ..... ..Sup-� S� �a -��.47 License # /'z.._.- `t. ..... Phone .... ..... ... Installation will serve: ResidenceApartment House C❑ Commercial ❑Trailer Court 0 Motel ❑Other.......... ...................... .... . . Number of living units:...... .._ Number.of bedrooms --- Grinder ._.. ------- Lot Size .....__-41_..��.._.......... Water Supply: Public System and name.......................................... ----••---•------••---------................................. ........Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 u 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: p (No septic tank or.seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK i ] Size................................................ Liquid Depth __... .................... Capacity .................... Type Material---------------------- No. Compartments ... .................. p Distance to nearest: Well ....................................Foundation ................. Prop. Line ....................... LEACHING LINE [ ] No. of Lines ........................ .Length of each line .......... Total Length ............................. IE r •D' Box Type Filter Material ....................Depth. Filter Material _................_..................... .---- E Distance to nearest: Well ________________________ Foundation _.____...__. .._ ._ • ._ _ - __ Property Line ........................ SEEPAGE PIT [ ) i Depth ..--------------- Diameter ___............. Number ----------- ........ Rock Filled Yes ❑ No i❑ Water Table Depth --...............................................Rock Size ._•-- •-----••--•-. .....---- Distance to nearest: Well .__ __.....Foundation ............. Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit+# -----..,.................................... Date .................................. r Septic Tank (Specify Requirements) ---------- f---------------------• - --- ------------ d'-40 , �7 Disposal Field (Specifyr Requirements) ........d 6L. . . Q. _.._: ........:...... , --- - 49 ------------- �*rtf? �....... �..-. _ lX ..Q. y + ................................................. ......................................................... _•------------------••-----------------•-•---------------•- --------....................... . ` (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- zed agents signature certifies the following: L3ti , "I certify that in the performance of the work for which this permit Is issued, 1 shall not employ any person in such manner as to became subject to Workman's Compensation laws of California." Signed Y i ne = - •:.......... .... :: ... ................................,.... Owner By ..... •---- ......_ . Title ....... _. ....'.................. ` .. . . . ...... . . . . . . (I oth an owner) _ 1 t FOR DEPARTMENT USE"ONLY. . APPLICATION ACCE ED`13Y ------- -----• :.. DATE 7 I BUILDING PERMIT ISSUED _________________________ .: ._..._DATE --------- .............................. . ADDITIONALCOMMENTS ....................................... ----------.._.._... ............. --------------------•-----------------------• ........................ �E .......................................................................................... ..............................................•......................................._._.............. r_�.._ ------------------ --------------- ..... ............__A�..... -• -------•--_...........-•--••-•-._..............._..._----..._.... .._......-----..........---•• ---- Final Inspection by: ..- .......... ................................ ..:•----•---••---------- Date. �� . ....... 4. _SAN..,,JOAQUIN LOCAL HEALTH DISTRICT 7/ a 1 u