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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y Permit No. ...73._`��b F (Complete in Triplicate) .......... ............:............])�. G- -73 U . ...... .. ... Date Issued .......�.......... ................................... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATIO .:....S.�.�g_._.1I��E��-i.�.�...........................................CENSUS TRACT .......................... Owner's Name ......---.. .+�1.V_0,. ... O.,S.l .tf't'.R ,....... Phone Address ..............•--..... b5 '`sem---........ -•-•...---............. City --.......-----.....---•-•--.._.:.-........ ----...............::......... Contractors Name ......__ :_�-_--�A+?O.S# S_-- ..........License #ez�5 -ate 7�-:.. Phone Installation will serve: Residence fApartment House❑ Commercial ❑Trailer Court Motel ❑ Other ............................ -------_------ Number of living units:......(._._ Number of bedrooms .3.....Garbage Grinder .... Lot Size .......-------:............................. Water Supply: Public System and name .......................-.---.................__........................ ...................................Private Character of soil to o deptk of 3 feet: Sand Silt❑ Clay ❑ ' Peat(D Sandy Loam ❑ Clay Loam E Hardpan ❑ Adobe; ] Fill Material .__..._._... If yes, type --._........--._....._-_.--• i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................................................ Liquid Depth .......................... Capacity ........... .... No. Compartments _..:.............. -•------------------ Type ............-------- Material .... Distance to nearest: Well ....................................Foundation ...___ --------- Prop. Line ....._..-_......... :.. 1 LEACHING LINE [ ] No. of Lines ........................ Length of each line._._......................... Total Length ............................ 'D' Box ............. Type Filter Material ---------Depth Filter, Material .______--•--. Distance to nearest: Well ........................ Foundation. _.... ............... Property Line .....-._.__-.___- ...... SEEPAGE PIT [ l Depth Diameter ................ Number ----...... _----- .... Rock Filled Yes ❑ No ❑ > Water Table Depth ..- ---•----- --- ........Rock Size ....._... ~ ---�-------- - {Line D stance to nearest: Well -----------•-..•---•--•---•-- ----•--...Foundation __._..`�-__.... Prop. Li .........�-....... ' I �. REPAIR/ADDITION 1Prev. Sanitation Permit# --•----...-•---------....................... Date .....---•• ---------------------..1 I Septic Tank (Specify Requirements) ' ._ - ...;....•.. r f r _..-• -- . Disposal Field (Specify Requirements) ...__..._.._. /V. -lit_ __. �........ ---••-- ------ --=----- ------ - --••�-• . � . ---------------- ------• ---•---- --- -- -.------- ------••- (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 following: a. y "I certify that in the performance of the work for which tris peimit is issued, 14hall not employ any person in such manner as to become subject to War an's Compensation laws of California." �� } Signed ... .............. ... Ow6ner -k---- --- By ------------- 1i ...•-••`- Title {If other t an owner] .,,E0R_DEPAR'fMENT_USE--ONL-Y .� • ...... DATE _.. APPLICATION ACCEPTED BY ..,Z ""' . --GY. c .... BUILDING PERMIT .ISSUED ..............._-_............................. ................. .....--••-...--------=-----•...--•--DATE.........------•--...wt......-•----•..-•---- ADDITIONALCOMMENTS ..........-----------.................................:............................................ ...................................................... --•-•---•......................................•=-------..:._..._.............._._..----------•-••.._.......------............-•-- ------...•---........-----•----•-----•.....-------------.. .......... ..................................................... .. .....:....: - - ...---•--. - •••-- 1 17 Final Inspection by: .... ........ ......•. --- -- - ------•--------._.---------••- Date :._._SAN'JOAQ IN -LOCAL HEALTH DISTRICT E. 7/72 3 iK H.1.3 241'='68 Rev. 5M � 4 y .