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FOR OFFICE USE- ------------------------------------------------------- SE: APPLICATION FOR SANITATION PERMIT ----- ----------------------------------- Permit No. -73= � (� (Complete in Triplicate) ------------ Date Issued _2�^_Z`? ----------------- 1 �--- :Z- - -7 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 mad in compliance with County Ordinance No. 549 and existing Rules a Regulations: JOB ADDRESS/LOCATIO 73" " `"`'s" j�� G/G -1 1 ----- ----- eNStfS TRACT - q � } - -7U-0 Owner's Name ------- l'( = Phone - ----- - ------- Address ---------------- SUJ- r City -------�...---------•-•-- Contractor's Name ------------- -- -__-- -- - -- -- ----------.License # _l__t�"Q_�L(_-__ Phone --- Installation will serve: Residence [Apartment House,F Commercial ❑Trailer Court i❑ Motel ❑Other ------------------------------------------- `4 Number of living units:----------- Number of bedrooms. ____...Garbage Grinder ------------ Lot Size O-r __ _7___ ___________ Water Supply: Public System and name ---------------------------------------------•--------------------•------------ -----------------------------Private` Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam '❑ Hardpan ❑ Adobe T` Fill Material ------------ If yes,type _______________________-__ X (Plot 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,] ` � I -------Depth _2— Capacity Type -------------------- Material__ No. Compartments .._---•----_-_._-_.-_. Distance to nearest: Well ________..�`r__D____________________Foundation ___ �___t______ Prop. Line .- _._- j ------ LEACHING LINE X No. of Lines -------�----------- Length of ach line; ___- - Total Length _la ___ ___________ 'D' Box ____-. Type Filter Material of-each Filter Material ____/-_-(f----------------/.............. Distance to nearest: Well D f_____ _ ndation ___C _�_ __-___ Property Line `___.__ __ r � SEEPAGE PIT Depth ---�-.__._____ Diameter - - umber ------�-------------- Rock Filled Yes No l 11 `,, * Water Table Depth -----------------------------------------_-----Rock Size _f - - ------------------ r . Distan-C6 to nearest: Well ------ ___ _____ `;-----------Foundation ___ __ ____ Prop. Line ---------------------- REPAIR/ADDITION __--------- ---_REPAIR/ADDITION(Prev. Sanitation Permit# -•-----•------------------------------------ Date ----------------------------------) Septic Tank (Specify Requirements) ----------------------------------------- --------------- ---------------------------- -----------------------•---- Disposal Field (Specify Requirements) ------------------------------------------f=-------------------------------------------------------------------------•--------------- ------------------------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- -�----- ---------------•--------------------------------------- ([?'r'aw 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: tf "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 w BY ----------C- y ------------------------------ Title ------ '-------------------- - ------------------------ (If oth t an owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ Y ____ -- - --------- --- DATE __-- - . -- -------------- ---- - ------------- - - - BUILDING PERMIT ISSUED D TE !/ a ADDITIONAL COMMENTS ------------ - --- - ---- ------------------------------------------------- -,�- --- ------�' J--- c Q �� ----------------------------------------------------- -----------------:----- /' _ /was ' -----c it c -----------Date,.--- 3- -r --------- Final Inspection by: .--------- ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT _ . E. H. 9 1-'68 Rev. 5M