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FOR OFFICE USE PPLICATIONN FOR SANITATION PER'"T ___-- _- _ --- - ------ �-. (Complete in Triplicate) %we Permit No. 73_.21.. ----------------------- 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: JOB ADDRESS/LOC N ` L 5 :7a4a'c- . rS ------ -------- - - CENSUS TRACT -.. - - Owner's Nor Phone _.._ c_.- _-y,Tt F- �i City ._ ------------------------------------------- AddressContractor's Name ----��`vit Z i A.License �� i rPhone .. . . Installation will serve: Residence Apartment House�Co er i I ❑Trailer Court ]] Motel E]Other_�}�:2-F_-. '--°� 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 ❑ Peat❑ Sandy Loam ❑ Clay Loam V 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: (No septic tank or seepage pit permitted if public sewer is.available within 200 feet,) j t PACKAGE TREATMENT [ ] SEPTIC TANKY] , `Size-y� __:,�_ --`-_X._S -__. Liquid Depth ..7 .-- Capacity Ia�QlType ___._.---___---_ Material.._ No. Compartments __-__. ,A 1/ Distance to near t: Well .__---____Jr4__ -_ . Fo daIter _ _.- Prop. Line---_S LEACHING LINE 1 No. of Lines ...._- ----------- Length of each line __.._ ---._._-- atal Length 1 D' Box _ .1_.. Type Filter Material _-_ S Depth aterial � _-_. _ j C Distance to nea e : Well --.__.O y Foundation -1_ �_- Property Line ' SEEPAGE PIT [rJ Depth --.-�5 - __ DiameterSl �,,-,,.._[[_ Number - _- / .--- Rock Filled Yes pl No ❑ Water Table Depth ............r _Jr_ __ ................ Size -_/-;��._.; _- - r Distance to nearest: Well -_�__ _.__ - ----Foundation ..../_-._---_-_-_ Prop. Line ---- .....--------- yyy 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 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 ----____ . ---- - _ t-_ - _ __- - By ----- ------ -- -- Title . (If other than owner) FOR DEPARTME T USE ONLY APPLICATION ACCEPTED BY -------------------------_. DATE __7K77/ :'.73-------- --- _ BUILDING PERMIT ISSUED - ---- ------------------------- _ .------------------------- ------------------------.DATE ADDITIONALCOMMENTS ------- ----------------------------- ------------------------------- --- ------- -------------------------- ----- - --_ -- - -- - - - ------------------7 --------- ---- ------ - ---- y� Final Inspection by: 4 Date --y-1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M