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.; FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT .......... .... .�-.........._..-•- -------....---•. Permit No. _.73.-//`�� (Complete in Triplicate) -.1(.- 73 ................... ............. Date Issued ../1.................. ..._._.- This Permit Exp ires 1I 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: JOB ADDRESS/LOCATION ............� ...... -----•....CENSUS TRACT .......................... Owner's Name . ... lfa...._ -._..I .C= _[.v!AFF.....__. . lws+�r, t .crf-S--/Y { C--.i )Phone ..... r �? . .. Address .........:............ ... � - ............................ City ....7 ------ --..................................... •-......._.........-- ....... ...... Contractor's Name .. ---.... � � _. Phone Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other . _- -- -=---- ------------_.._--.--------- Number of living units:.. ._.... Number of bedrooms ... ...-Garbage Grinder ...... Lot Size ..._ - . _5i ............ ......•-• Water Supply: Public System and name .................. -----.-....._._ _= Private Character of soil to a depth of 3 feet: San Silt ❑ Clay ❑ Peat❑ Sandy Loam'ft Clay Loam ❑ Hardpan E] 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.) NEVA INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (Ir•� r � PACKAGE TREATMENT [ ] SEPTIC TANK Size......to-Z V,). ......................- Liquid Depth ------- Capacity Type rv- -. ,k- Material--. No. Compartments V�.................. Distance to nearest: Well . ................Foundation ...._to f......... Prop. Line _.S r' ........ LEACHING LINE No. of Lines Length of a ch line ........(?t'). .... Total Length ------- 'D' •----'D' Sox .. Type Filter Material _.. ,r_.._Depth Filter Material ..._ ...............................� r e Distance to nearest: Well ......5-6._..-._. foundation ............ Property Line .. .............. SEEPAGE PIT [ J Depth . . ........ Diameter ................ Number ..... . . .............. 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) .... - -- ------ -----------• ---------------------------------------------- --.........-...............................................V, Disposal Field (Specify Requirements) -------------------------•------- ------ ......... .._.. ------ ------- •. . . ..._._....------... ............. ................ .:................--------- ----- . --- ------ ......-....----------- �.._......,....__- - _ ==x...�. .. .. .--...-.—.--•- _ ...._ ............. (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 become subject to Workma ,s Compensation laws of California." Signed . Owner By ... .. _.Ad _... .._ Title.f other than FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... . -------- ------- ..... DATE •------•---- BUILDING PERMIT ISSUED .. ... ... ... ........ . -- •--- ---..-....... .. .. ... .. ..... .-..DATE . ............-----------_•------...... ADDITIONALCOMMENTS ................. ..-- -•- .... _1................................. ..........---- -• •-........... --. ---•- •-. ................ .............. --------------------- .................... -----......----- ..-......-----•-... .. ------.-- ,� FinalInspection by, .................. ........................................... •-• -••----- . ..... .........Date _.. Dom'/�---------•..--•--....._. SAN JOAQUIN LOCAL HEALT (STRICT 13 24 772 3 K F_ i•1_ 1-'66 Rev. 5M --