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FOR OFFICE USE: ), .PLICATION FOR SANITATION PERM*./ 73-AI33 (Complete in Triplicate) Permit No. ..................... ......................_.._------.._.._._.._---- This Permit Expires 1 Year From Date Issued Date Issued h5�...3.. 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/LOCATIQN .- --� .0 9 ) 2� 4 �?...K .................-CENSUS TRACT .............. Owner's Name LA � - - -----•• -- -------._ _."----- --- fJ- .. Ph�onre_E--............./ - - ---- •------•---....-- Address ... ..y ............. Ci»nse 'Contractor's Name .-----. ywt / +:�o .._ �Lite1 _7. :E ". Phond-.-.........................- installation will serve: Residence❑Apartment House Commercial]]Trailer Court 0 .. Motel ❑Other ..el s- _._i _...L_ Number of living units:.... Number of bedrooms _Y...Gorboge Grinder ------------ Lot Size ---y_�.k'_ r Water Supply: Public System and name ------------------------ ---------—....................—.......-------------_-------•--•----•...........Private Q' . Character of soil to a depth of 3 feet: Sand❑ /Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 Hardpan 2d Adobe j] Fill Material .__.- ----If yes,type------_---_-------------- (Plot ----- ---_--------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc must be placed on reverse side.) ti NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200feet,) ` PACKAGE TREATMENT [ ] SEPTIC TANK ] Size---------------------------------------- Liquid Depth ..... ......... Capacity ----------------- Type .................... Material-----_-----------A--- No. Compartments -------- - - Distance to nearest: Well ---------------------_............Foundation ----------._......... Prop. Line..._....__.-_.._. LEACHING LINE [ ) No. of Lines _.___._---_-.._.____ Length' of each line.---.-__-_-.--_-..__ Total Length ,.___-..,...-._.___._. 'D' Box ............ Type Filter Material :.__---------------Depth Filter Material .......—-----_------------_-----_----- Distance to nearest: Well ........................ Foundation -___ -----........... Property Line _-....._------._------ SEEPAGE PIT [ J Depth -------------------- Diameter ---------------- Number .........._---------------- Rods Filled Yes ❑ No ❑I _ Water Table Depth ...------------_-----------......_-..........Rock Size _-----------------------.- Distance to nearest: Well -----------_---------------- --------Foundation ---------.......... Prop. Line -------___....__--- { REPAIR/ADDITION(Prev. Sanitation Permit 5(L ............................................ Date -----------------------------I Septic Tank (Specify Requirements) -_-_----------------_-----•- ------•--••--------------•---•-•-------------------_--•.---------------------------... Disposal Field (Specify Requir encs) ------G-'�-'-'+�--- ------- --- b= zS la`s-`�'''` �4---•---f. ---- - --- (Draw existing and required addition on reverse side) LI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 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 r- By -- -- =a. -/%i. ----. Title d� hi !L+? {h -------------------------- - ------ --- -- (lf other n owner) 0 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYlit U ---1------------- ............ - --------------- DATE --- BUILDING PERMIT ISSUED ........ ---- ------------------------------------------------------------ -------------------DATE . ---.. ------------ ADDITIONALCOMMENTS .......................................... ...... .............—............................... -.. ...... ............... ----------------- --•--•--------------------------...............................---------- -------•------- ----------------------------•--------------- ------.-----_------------------ --y¢ ---- ---... A ��.................. ---------------------�------------Date ' Final Inspection by: -�- - - - -:- -=JJ:�...,.<�- =--------------------------•----- ... -'- ----------................... SAN JOAQUIN LOCAL HEALTH DISTRICT a