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y 3` `a FOR OFFICE USE: APPLICATION FOD SANITATION PERMIT zY r rr .................................................... Permit No 73. •r (Complete in Triplicate) / ls. - ...................................... This Permit Expires 1 Year From Date Issued Date Issued �,rs,�? •- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heel } ic4 described. This application is made in compliance with.County Ordinance No. 549 and existing Rules and Regulotionsi" �4c JOB ADDRESS/LOC O�.0..�.6..�...... .v4.r.: .... . .. IGG�..................... CENSUS:.TRACT 6 .. Owner's Name .... . ...... .. Phone J �0. (J / L • ...tih'LNrf �<.' S d � „ Address .. _...._.. r. .., Contractor's Name ... . ..... /L �' .•.Li # `XY-S�Y Phone .._.. cense .' Installation will serve: ResidenceApartment House'❑ Commercial Trailer Court Q _ Motel ❑Other .......... ............................. r Number of,living units: ---t... Number of bedrooms .....Garbage Grinder ... lot Size Water Supply: Public System and name ........Private .' Character of soil to a depth of 3 feet: Sand Q Silt p Clay E) Peat❑ Sandy Loam Clay Loam❑ , "� Hardpan ❑ Adobe ❑ Fill Material If yes,type.......... r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse 1 6: 5 r 4: a NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK j ] Size. ...... ......................... ........ Liquid Depth `t s s -"Capacity .. TYPe- .......... Material...................... No. Compartments ................ Distance to nearest: Well .................Foundation . ..............._.._ Prop,line LEACHING LINE ( 1 No. of Lines .. Length of each line .... .... .. .. ...... Total Length ..... .... ........ f 'D' Box Type Filter Material . .............. ..Depth Filter Material ........................... f rt Distance to nearest: WeIL.... Foundation Property Line F SEEPAGE PIT ( J Depth ...... Diameter .............. Number .......... ._.........___.. Rock Filled Yes Q No Water Table Depth Rock Size .. ...................... Foundation ............. Prop. Line zDistance to nearest: Well ...:.::.a...................... z _ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- Date .._..._._. .................•.) Septic Tank (Specify Requirements) .................... p� / "a""" ... Disposal Field Specify Re rements) --- . .. '`c t' j x w - ✓ .-. .b.� c- ..... .......................... _ _._ ... ... ..... .. _ ...................................... . .. .... .... ...... .. .. . . ............ (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 Sen "Joaquin 3Y �. County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Dlstriet. Home owner'or [icon- sed agents signature certifies the foll3wing: s issued, 1 shall not employ any person in such manner "I certify that in the performance of :he work for which this permit i v as to become subject to Workman' ensation laws of California." Signed ---- . _ caner O tie g (if other than ow er) QOR DEPARTMENT USE ONLY sDATE ...`4.-5.. ..7Z-------- 5Z.7 u APPLICATION ACCEPTED 8Y...... !- . ... .............................................. . .. ' { ......SATE ................._.........BUILDING PERMIT ISSUED ......... ..... ... .................................•--.................................................. . ADDITIONALCOMMENTS .................................................................._......................................................--•--.........._..................... ................................................................. ................................................................ >. .................... ...._..... ........................................................I................._.. ............... ....... Date ... . ........................... Final Inspection by: ... - �'-'.-""""""'•- SAN J AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M t r x...