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r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------- -- 73- zs (Complete in Triplicate) Permit No- - -------------------- -------------- This Permit Expires 1 Year From Date Issued Date Issued ---- �_--7-3. 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 ADDRE55/LOCATIONI _ ----___---- _-------------------------CENSUS TRACT - _ ,136--I1 - - Owner's Name - ,/�lv✓ ------ �C� S = -------Phone Addressr • ---��-------------------------------------------- Ci hr �.S�Gt3 Contractor's Name __ - 1�� - - ----License # � /_�3_ Phone Installation will serve: Residence ❑ Apartment House❑ Commercial XTrailer Court ;❑ Motel ❑Other Number of living units;--- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ----------------------------------- ........ Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay .0 Peat❑ Sandy Loam •❑ Clay Loam ❑ (� Hardpan ❑ Adobe ❑ Fill Material Af yes, type ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, (� E ] [ ] — 5 ----------- o. PACKAGE TREATMENT SEPTIC TANK� Size_--_--_ -__ _-_--- Liquid Depth -_��-------------- Capacity O-0----___- Type - Material_1�zrs _ No. Compartments ----. r 1 . Distance to nearest: Well ----�irc.t—-------------Foundation _16)------------- Prop. Line ..,�__!--_-_---.-- a LEACHING LINE { ] No. of Lines -----f---------------- Length of each line____�0---------------- Total Length -r 'D' Box / �----------.---- ��--_- Type Filter Material �_ X-AF----Depth Filter Material ------,fes-------------------- Distance to nearest: Well __ z4e.r_------ Foundation ---la--------------- Property Line ---------- - ---.------- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation ---------------.---- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------------------•----------------------------- Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- ------------------------------------------------------ - - - - ------------------------------------------------------------ (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- sed agents signature certifies the followings "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 becom ct to YVor man's Co pensation laws of California." Signed ----------- Owner By --------- Title ------- (If other than owns FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------- ---- DATE ---�S o� �3-------------------- BUILDING PERMIT ISSUED y_ U!L_ --- DATE ADDITIONAL COMMENTS ------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- ---------------------------------------------------------------------------------- ------------- --- --------- 1 FinalInspection by: -------------------------------------------------------------------------------------- ---- --------- ate _- SAN JOAQUIN LOCAL HEALTH DI RICT Y E. H. 9 1-'68 Rev. 5M r.