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FOR OFFICE USE: APN.a:ATION FOR SANITATION PERMIT ,er eo Permit No. ..73-� (Complete in Triplicate) 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 hereir scribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA ]ION//� 2 _--1 r� /.' _ -f -:( ..... ....CENSUS TRACT ....." . ..... r'vner's Name _ lt-":)_%. . . i r -• - --- ----------Phone -..... .... �_Idress ------------------- -- -- ' L-- -.. - -,- [ r;. -s::" ------- _--- --_ - m".C12", j?!' j _ l�-".../(-�..-. city '�I.•Y��r�:d.---....-- - " Contractor's Name .--"r „lYtcrly-"-_�cn`?!,,•:..". f.r JP�." ....... -..License :.. Phone ..........----------."..-.... I otallation will serve: Residence eApartment House-E] Commercial ❑Trailer Court I] Motel ❑ Other Number of living units:._....._. Number of bedrooms _.-Y.-Garbage Grinder .... Lot Size -."e�5-_�"t •• ` oter Supply: Public System and name --- -------------------- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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.) I 'W INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t-ACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size--.-..""_". ---_------ - - .. _ _ ._- Liquid Depth ........................". Capacity ....-__-...... ... Type --------------- Material ... _. _. No. Compartments W _ Distance to nearest Well - ---- __-.__.-_ Foundation -.___.__-__ Prop. Line --------------------- LEACHING "- "LEACHING LINE [ ] No. of Lines __- _ ------------- Length of each line _ - Total Length (tr 'D' Box ___-"-"_ Type Filter Material -----------_.--""""Depth Filter Material __.__-"_"-""""__"""_"_"--"-"-"---------. Distance to nearest: Well --"-"""-- Foundation _._________ Property Line ""-"""-"""--"""--"-""""" - SEEPAGE PIT ( ] Depth ""__ - - -..._.. Diameter -"__""""""""".-" Number __.__- ___.__._. Rock Filled Yes ❑ No ❑ Water Table Depth ----_-_._....----------"-"""--------"Rock Size -....... ... Distance To nearest: Well ...."".""""-"""-""-_""""""--"""-"""-""""Foundation .................... Prop. Line ..-"-.-""""-------""-- r0 M I PAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------- Dare _--------------------------------) Septic Tank (Specify Requirements) -._- ... . ---- /'-------------------------------------- - _ -- _ - "-""" Disposal Field (Specify Requirements) � -K,.P 'J.L ti 1..f..:11 tr _ _ �,(`� _ r - - - __- i N ` ` -- -- - --- Aow ....................... __ ___ _ _____ __ __ _ (Draw existing and required addition on reverse side) I iereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Lounty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner c—to become subject to Workman's Compensation laws of California." Signed - . - - ...... Owner �/ E --------------------------- (if (� lG-- - Title .--['-<T/Ll r aid-��'i f _ ----------------------- _ other than owner) FOR DEPARTMENT USE ONLY 'PLICATION ACCEPTED BY - ---- - -- f ---`--' ----_.. --------- --------- DATE --f-pp--- ................ ITILDING PERMIT ISSUED .- --- - _------- .......DATE .__... ................................. ADDITIONAL COMMENTS "--------"" """"-- ----- --------------------------------- - -- ----------"--"--------------------- ----------- - -----------------------------_ - - - - - ----- --------- -------............................................... - - --- ------------- -- '-----' ----- ---- --- --- - Final Inspection by: .----__------rC.r..--............ - --- -----------------Date _,1171 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ti�