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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............. -- - -_--•- ------- � Permit No. . 75--72o' Tp S b (Comp)ete In Triplicate) /. ... . . ! . ....•4_?�11... .._ 1�3 Date Issued .-:1.4z.. ........... ........................ This Permit Expires 1 Year From Dote Issued 1.. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work !retain described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .C �'. ..... CENSUS TRACT . l/.............. Owner's Name , . . .............ice' - ......... ... �.................................................Phone .................................... Address ` _ _.. . City ......... ......... Contractor's Name ..... ...-- t✓ .. ...................License# .�.�r�,3(t' ... Phone _..L..- /�i `�'17 7 Installation will serve: Residence p Apartment House Commercial❑Trailer Court 0 Motel Q Other.... ...................................... Number of living units:........ ... Number of bedrooms ............Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name .................................................Private❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom❑ Gay Loam ❑ Hardpan❑ Adobe❑ Fill Material ............ If yes,type............... ............ (Plot pian, 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,) PACKAGE TREATMENT [ ) SEPTIC TANK i j Size......................:......................... Liquid Depth .•._-•... ......... Capacity Type Material...................... No. Compartments Distance to nearest: Well ................ ...............Foundation ...................... Prop. Line .....................� LEACHING LINE [ j No. of Lines ...I.................. Length of each line-.._.T,............ Total Length ..V-e................ 'D' Box ------------ Type Filter Material ....................Depth Fitter Material ................ . .............. ........ Distance to nearest: Well ........................ Foundation ---..//_............._. Property Line ..............•....... SEEPAGE PIT [ l Depth'1'_ x� ypmeter ................ Number ........1.................. Rock Filled Yes No > Water Table'•Depth ........ .....................................Rock Size ..._............•._....._...•— Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# _.-_..----•................................. Date ...-..............................) SepticTank (Specify Requirements) ---•---•--•..............•-•--•---....---••---.._.................--......._............_....---........._....................._............ 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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Heath DiSMd. Moura owner or How 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 become subject to Workman's Compensation laws of California." Signed . `�'� --------------- Owner By ..._ . ... E_ � .. title _.::......... ... , (If other than owner) _ _ DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1.0� �_. ..................... DATE /0 .f,V/7�..-__......_. BUILDING PERMIT ISSUED .............. .. ._.DATE -...--.. ----------------------------- ADDITIONAL COMMENTS ....................... ._._...................._.............................. .................... ... ....................... .......................................................................................---- -...._._...._...._...-----.I...... ...................... . .--- ---- .. .. ._..--..............- ----.................... . _.. -- -. ......,........ ............... . Final Inspection by: - ........................................................ . ...Date .� 7q3 ......._... EN 13 2L 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7b 3M