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nAL, ':>-.e X_A' d n FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ ----- Permit No: ...7 73 / �. 4Complete In Triplicate) ........ .............................................. 1 Date Issued -3 --------- 3 :...................................................... /Y 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. 544 and existing Rules and Regulations: . _ _- Cr ._ ----------• 1-41........ JOB ADDRESS/L TION . �__-._.�... �....._.. -.•-....... . ... . -------•-.•_--CENSUS TRACT ..S_�... Owner's Name .. --- . .. -•---- Phone................................---- Address6.p ----._.. r.._:1 ..- -•------• ---- City ...... .................................................. Contractor's Name .---- - -•-- _ ...... i.License* _/,gFf.,.?.F.1Phone .............................. Installation will serve: - Residence❑Apartment House-F] Commercial E]Trailer Court ❑. Motel ❑Other_11� --1 Number of living units:.... ...... Number of bedrooms ..______._..Garbage Grinder ------------ Lot Size Water Supply: Public System and name ....................... .._... ._....._._. _ .........Private [ � �Choracter.of,soil_to_depth of 3 feet:,;�Sand aSilt❑ Clay,❑Peat❑ Sa dyloam fY Clay Loam.n -� Hardpan❑ Adobe fl Fill Material ------------ If yes,type............................ (Prot 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 it ermitted if public sewer is available within 200 feet 4 ( .1 PP permitted P 14 PACKAGE TREATMENT { ] SEPTIC TANK V 5izey" -_.X 9... ______ ____ Liquid Depth -------------_ ._. Capacity __f -A_.�.. Type Material.- __ No. Compartments .ate........... 1 ------------------ Distance to nearest Well ---------- .. ................Foundation� Prop. Line ........ .. -..._-f '� LEACHING LINE [ No. of Lines ......... Length of each line....... Total Length ......... `D' Box 'mss..... Type Filter Material ..=SAF......Depth Filter Material .__ ........................ dr S ....T Distance to nearest: Well _._ .Q__�.._-_____ Foundation _____ _......_.... Property Lln�. ....: .. SiSPWAGE 04 l ` X 8 . Number --------- ------ ------- Rock Filled �lYe$ � No 0 Depth /:�.----•--- er _._..... ..... Water Table Depth --------------2¢-------•------.--.........Rock Size .. el _. Distance to nearest: Well --------/00 ...............Foundation __.1P............ Prop. Line .� __..__....__.. -f ..... - REPAIR/ADDITION(Prev. Sanitation Permit# •------------------------------------------- Date ................--------------_.__) i i.f y Septic Tank (Specify Requirements) _____________ •- DisposalField (Specify Requirements) ---------••------------------------------•-•------•-:------............... .....--•--.......-----••-•--•-----............•--....... .. .,��...:. IDraw 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 air licen- sed agents signature certifies the following: "I certify that in the perFormance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ....................... ------ �} --•--- Owner By ---..._. --- _ . 'JR''r._. ;dile .. .. ... .. ---------------•-----------------------•- (if other than owner) POOR 1:1'EPARTMEW'USE ONLY APPLICATION ACCEPTED BY ... f --•---- -----•-•---------------------------------------------------------------- DATE -------------- BUILDING PERMIT ISSUED .........---•-------------------------------------------------------------------- ----------------------DATE.-••--_.... ADDITIONALCOMMENTS ...............................•........:...................................................................................................................... Final Inspection by: ----• bate SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1-'68 Rev. SM ,