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FOR OFFICE USE: i APPLICATION FOR SANITATION PERMIT Permit No. _7--- ----- _ (Complete in Triplicate - --------- ---- Date Issued . .'-..-..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 _.-I..� .- ..-.4.E --.�---�'� //V- ---- -......-.CENSUS TRACT ..... ........... ...... Owner's Name ..._ !'�/�-- 'c�?�Ye�1 .�---. ... ................... ......Phone �, yb.7... Gtr. C 2- r>1 f ,eo fid- City zi � Address _. I Contractor's Name :.J;�- ------ W14>----- --------- - - -----license .T --- Phone - I J � Installation will serve: Residence {Apartment House❑ Commercial ❑Trailer Court 0 Motel Q Other --------- ---------- ------- Number of living units:... Number of bedrooms _35----- Grinder --- ._.. Lot Size ---_ .. -_.- ----- .................. k Water Supply: Public System and name ..__ Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i 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 wi in 200 feet,) 1 PACKAGE TREATMENT { ] SEPTIC TANK{ ] /th ze------------ -- -------- - ;quid .Depth ----------------.......... 1 Capacity --' ------------- Type ---- ...... Mater' I.----- --- --------- Distance ------- . o. Compartments = .._.....:.._. V Distance to nearest: Well ................ Foundation . Prop. Line ._......_..._........ LEACHING LINE [ ] No. of Lines -_._._-.-_ --.-. . Lof a line----_--. __-- .-- - ---- Total Length _--_---------------------- 'D' Box .... - Type Filter M --- -------- ------Depth Iter Material ...__...-:-- ..--------------............... Distance to nearest: Well ..... Foundation Property Line -......._..__._.---...-- SEEPAGE PIT [ � Depth Diameter -------- Numbe, -.-...- ----- --------- Rock Filled Yes ❑ No ❑Water Table Depth --------- •------ ock Size ------ ---------- ..------ Distance to`nearest: Well _..Foundation _... t..-- Prop. Line ................................... REPAIR/ADDITION(Prev. Sanitation 1Permit# ----- -- ---- Date ------------------------`--------)" ! ------------- Septic Tank (Specify Requir/ements-)!�?�.� �--.. - Disposa] Field (Specify Requirements) i%-J - , ---- ------------------� ----------- I -------- - - - - ----------- ----- (Draw existing and required addition on reverse si e) I hereby certify that 1 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- 1 sed agents signature certifies the following: "I certify that in the performance of the work for Which this permit is issued, I shall not employyany person In such manner ! as to become subject to Workman's Compensation laws of California." -_- Owner Signed ---- ..--- -- --- ---- ------------------- -- ---- By ..... Jitle ....... --------- .............. ---------_-- (If of er than owner] FOR DEPARTM T NLY ' APPLICATION ACCEPTED BY .- :... .. - �' .1--.---. DATE --•--- =7 -- ----------- BUILDING PERMIT ISSUED ------------------------------------ ..DATE :. ADDITIONAL COMMENTS ------------------------------------ ------ ----------_ ..........................................: •...._. ................................ { -----------------------------------=-------------------------------------------------------------------------------------------------------------------- ------------------------------ --------- /TRIC 73- ----------------- Final Inspection b .. _..-.Date .... � --•------ SAN JOAQUIN LOCAL.HEALTH D Cb E. H. 9 1-'68 Rev. 5M