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FOR OFFICE USE: APPLICATION–FOR _SANITATION .PERMIT 7 -------------------------------'J`------- ` ,`- permit No. _73---�.5------ (Complete in Triplicate) - t ----------•------------------------------------ L v i Date Issued --------------------------------------------------- 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: j JOB ADDRESS/LOCATION ---A --------- L � ' __ J�l9vC---------------------------------CENSUS TRACT -----------------.-------. Owner's Name _ '/ �-------l0ee',ex -------------•-------------------------------- Phone --------------------------- ------- Address Address ----/X&s�---_ <- /'1',5T ------------------------------------------- City --SfZ)-ci 7W7WIV-------------------------------- Contractor's Name r------------ -------License# /_`7.7-19'73 Phone �- Installation will serve: Residence [XApartment House❑ Commercial !❑Trailer Court Motel ❑ Other ------------------------------------------- Number of living units:... Number of bedrooms ___42____Garbage Grinder _1Y&__ Lot Size --------------------- Water Supply: Public System and name ------------------------ ----------- -------------------------------------------------------------------._------Private ❑ k � Character of soil to a depth of 3 feet: Sand'[] Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ `Adobe Z ' Fill Material ------------ If yes, type _______________ (PI'ot 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 within 200 feet,) O 11 r r "r ) PACKAGE TREATMENT [ ] SEPTIC TANK Size-__/ -. �s--y ------ Liquid Depth __-_V -Ip�v�t'--- f Type � aterial L No. Compartments —A_------------- Distance to nearest:(Well --____________________Foundation ----1G'__dr_-------- Prop. Line __ ________________ i LEACHING LINE No. of Lines ___ ______------------ Length of each fine---IeV-------------- Total Length _40a/ ---___:______--_ y 'D' Boxes_ Type Filter Material _ a��c-_Depth Filter Material ---/-_7___---___________________------- _ i r i Distance to nearest: Well --- _______________ Foundation ---.l4_____._--_---- Property Line. _-max ________.__-:____ SEEPAGE PIT X Depth ------- Diameter 3-i�-------- Number ------1------------------- Rock Filled Yes Z No i❑ Water Table Depth -------------------------------- Rock Size ` --- 1 r -/__O/ DO -- - � - -- Distance to nearest: Well _` --------------------------------- ___ ------ Prop. Line__2'!f�.... REPAIR/ADDITION(Prev. Sanitation Permit# ------ Date ----------------------------------) Septic Tank {Specify Requirements) ------------I-------- ------------------------------------+----------------------------- i Disposal Field (Specify Requirements) -----------------------------•--------------------- -------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------------- (Draw 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 or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to became subject to Workman's Compensation laws of California." j Signed ------------------/erih�an -------- -- -------- - -------------------------------------- Owner By - -- ---------------------------------------- Title _.. �'1ur�l__P? -------------------------- (if of rl 15;. FOR .DEPA1tUUNT USE ONLY APPLICATION ACCEPTED BY ____-- DATE ----- _-_. -- --- ----- BUILDINGPERMIT ISSUED ------ ------------------------------------------------------ ---------------------"------- --------------DATE - ----------------------------------------- ADDITIONALCOMMENTS ------------------ ------------ -------------------------------------------------------------------------------------------------- --------------------------- ---------- ---- -- -------------------- ------------------------------------------------------- --j-- . --`-------- ---------------- ------ ------------.4-- ------ ----- Final Inspection by: - -- ----------------------------------------------------------- --------- -----------------------Date - H- ° �- ----J---- SAYN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,