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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -- ----------- ----- 'Complete in Triplicatel, 'r Permit No.'73-7-s1---- � --------------------------------------------------------- -- _ Date Issued ._gr_��-73 _________________________________________________________ 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ---- ,6 sou-T-'q t� _S /9--------------------------------------CENSUS TRACT -------------------/-------3 Owner's Name �tIY� - Xi�_ _7- --------------------------------------------------Phone Address .-9,112.---`5' c 5 --------=------------------------- ------------------ - City ------ -------------------------•------ Contractor's Name tl_l_. _CDm_[ )R_Tg,-----W.I)ALicense # ------------ ------ Phone --------------------- Installation will serve: Residence g Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑ Other(/0019 --- - -�L ----- ---a M E - Number of living units:__.;_.._ Number of bedrooms -----1___Garbage Grinder ....AJ'0__ Lot Size -------- Water _____Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private 52. Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E]. Peat ❑ Sandy Loam •❑ Clay Loam :El Hardpan ❑ AclobeX 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,] .D PACKAGE TREATMENT [ SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth ---_---------------------- Or Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ---------------------- 113 Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line ________............__ ' LEACHING LINE [ ] No. of Lines ________________________ Length of each line--.------------------------- Total Length r1 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------.----_----------------.- 11'+ Distance to nearest: Well .----------------------- Foundation ------------------------ Property Line _--____-_________._.__. SEEPAGE PIT [ Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth -----------------------------•-- ---------------Rock Size -------------------------------- Distance to nearest: Well ii----------------------------------------Foundation --------------------- Prop. Line ----------............ REPAIR/ADDITION rev. Sanitation Permit# _-_____G.�_5_ _ ____________ __,Date eptic Tank (Specify Requirements) OO - - 1FN Disposal Field (Specify Requirements) --�1YgA ---------- ---------------- -------- -------------- e - %----------,--- -- -- -------------- - � e -- -- ------ --- ------------ -----------------I---------------- V (Draw existing and required additi on re rse 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 becoW subject to Workman's Compens ition laws of California." Signed --. ------ r ------------------------------ Owner By --- -- --------- -------------------- -------------'S ----------- Title - - - - -- - - --- - - - - --------------- (If other than owner) ) 7 -� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._UmA.___..__ 7------------------------------------------. DATE -----__ �4' �7-------- BUILDING ' BUILDING PERMIT ISSUED •_ -----DATE ------- ---------------- ADDITIONAL COMMENTS -- _ _ _ __-- _ ---------r- -- --- - -- ------------- --- -- ---- ------------------------- ---- r ---- ------ _____________________________ R _ _ __-_ e A ------------------------------------------------------------ �___ __ _ _ __a______ ______ ____`-_ ---_ _ ____-. _ _ - ___ - _ --------- ,s _____-__.__________________________________________________�_S___-_ - _ _ Final Inspection by: -------------------------------- -----Date --------------------------------------- - SAN JOAQUIN LOWr HEALTH DISTRICT - � I E. H. 9 1-'68 Re: i 5M =