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azs- FOR OFFICE USE: APPLICATION FOR SANITATION PEI 'T `/ `.w Permit No. ._73- (Complete in Triplicate) This Permit Expires 1 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: r JOB ADDRESS/LOCATION --- 5Q _ILCP�I{(-/U�'.--_-- J � __--.-_-_-CENSUS TRACT ___-_--.-- Owner's Name --- •16,00---------)Q_,"/-------------------.. -- -------- --------------- --------Phone .Y79 Y ----- Address ---- SWW/A ------------n--------t�-�--------------------------------- -------...-.._ City ----------------------------- -------------- -----y--�------------ Contractor's Name _ _r;�F --��s_-f--�.l. ---r�,A1.k------------------License # ---- Phone Installation will serve: Residence X Apartment House❑ Commercial ❑Trailer Court Cl ., Motel ❑ Other Number of living units:----I------ Number of bedrooms -1_--Garbage Grinder ----- Lot Size P_l k?,* )----_-----_---.._ Water Supply: Public System and name -----------------------------____----------------------------------------- -----------------------.Private [� Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loom 0 Hardpan ❑ Adobe 0 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,) i PACKAGE TREATMENT [ I SEPTIC TANK fA Size.4.1( ._Y S .'--._-..--- Liquid Depth -y�_.-_.-__..,.._-. Capacity/K74A L.t"�1--- TypeP�FG _MateriakfOAI,./�No. Compartments e--_..._.-.:..-. 0 Distance to nearest: Well - _`---__----___._.--_-_Foundation .l8`-------------- Prop. Line . `-----------_- \ LEACHING LINE J No. of Lines ----------------- Length of each line /412 Total Length /Qp.-_______________ 'D' Box NO._ Type Filter Material 10 "-._-Depth Filter Material _/9---------------..-.--.--.--------.- ` Distance/ntoo nearest: Well ----_.-___�l- Foundation 10./.--_--------- Property Line 3' ...._.-_.-.___ SEEPAGE PIT [p� Depth .D�f -- ----- Diameter -3�------- Number ----/---_ ---------------- Rock Filled Yes qR No i❑ i i Water Table Depth ------��-i___-------------------Rock Size .�- -�/J-__._.-------- i - -�----- -- Pro Line A-... Distance to nearest: Well __/P.�'-------__--._--.--.--_,_ Foundation p. REPAIR/ADDITION(Prev. Sanitation Permit# --------._--_ -------- Date ---------------------------------- Septic _-----_-----.._.---_----_--_Septic Tank (Specify Requirements) -------------------------------------------- Disposal Field (Specify Requirements) ----------------------- -------------------- --------------------------------------------------------- --------------------------' (Draw existing and required addition on reverse side) 1 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 become subject to Workman's Compensation laws of California." Signed ...-------------- - A -- - ---- -- __ _ Owner By .._........ Title - - -------- - (If Therth '` �- - - FO .DEPARTMENT LlSf ONLY APPLICATION ACCEPTED BY - - -------- DATE - ` BUILDING PERMIT ISSUED . ---- - - -------- ------------- ---DATE ------ - -------------------- ---------- ADDITIONALCOMMENTS -------- ----------------- -----j---------- -- --------------- ---------- - ------------ ------------------------- ------------------------ ------------------------- -------------------- ------------------- -- ------ -- --------�- ---- -- - - - - ----------- ----------- - -- ir. ---------------------- -------- --- - - --- - - - - --. _.--- - ---- ------ '�/ Final Inspection by: -----/-- --------- ---- - - - ---------------------------------Date ---- ------Fh-(- ------ -- SAN JOAQUI LOCAL HEALTH DISTRICT ' bw E. H. 9 1-'68 Rev. 5M