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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .. ....:............. ............. ................. -73 ........................ This Permit Expires 1 Year From Date Issued Date Issued ./O.--36. Application is hereby made to the San Joaquin Local.Health.DistrictV for;a. perrnflt to construct and install the work herein described, This application is made in compliance with CouAfy Ordinance No. 549 and existing Rules and Regulbtions:.j� — JOB ADDRESSAOCATiON ,:-s -l..._,. c ._ .. .............................. .........CENSUS TRACT ..........I............... Owner's Name ... ,� , rY' -Phone .................................... Address ----- /i', VJ !,...... City L:57,7 ............. Contractor's Name ..-.../ - __ /A �r% License #of,J• �._ Phone. ---•--- Instailation will serve: Residence Apartment House] Commercial :❑Trailer Court Motel ❑Other _"`_..::... ..........t Number of living units:-./.---.- Number.. of bedrooms ------Garbage Grinder Lot Size u'e ... ................. t ) Water Supply: Public System and name --••------•......................•......._..._.........-_...•-•-.....-._._.................•---••-••---•--•--.Private i Character of soil to depth of 3 feet: Sand❑ . Silt C3 Clay ❑ Peat,[3:4 Sandy Loam F] Clay Loam D Hardpan [3 Adobe go Fill Material .........—A A If yes,type ............................ (Plot plan, showing size of lot, location of system in relation to wells,c buildings, etc. must be placed on reverse side.) �) „r j NEW INSTALLATION: (No septic tank or seepage pit permitted ifpublic sewer is available within 200 feet,) PACKAGE TREATMENT ' ` _______ Liquid Depth , -._._ .-. .-- > [ l SEPTIC TAi�1K1(J R Siae.� ir �.i .---------•:---- . f , Capacity/��_-.-. Typ/.o` -W.....I Moterial: ---' No. Compartments 3 Distance to nearest: ...................Foundation l—-__-_.-_-- Prop. Line f�'........... LEACHING LINT:,- NDo.B zLines e-�a Filter Mategria(/ � • D>��..•__:...'..._._ Total Length �.�Y�................ , 4/� Length #.I each IRne.- Filter Anterial lex--1.. ............................ Distan a to nearest: Well ..��............ Foundation -. + ........... Property Line _147_............ ' SEEPAGE PIT kj Depth .c - -_._-_ Diameter ... Number -. --------------------- Rack Filled Yeses' No ... Water Table Depth -_Rock Size ` Distance to nearest'Weil....-`_.. .....................Foundation f.. ....... Prop. Line ..vr------------- i REPAIR/ADDITION(Prev. Sanitation Permit# Date , ) t�� Septic Tank (Specify Requirements)- ; -_:. ) A� ...........................................-----......----•-..........----•-._...-- --••------- r . t Disposal Field (Specify Requirements) '"_:_._ ------ r '�. ---------------------- ..... ---------------------•-------- .............. I . . j ..-........................ ----------------- ----------------------------------------------------------------------- ;a --------- ----- ------•--•------- ------ --------- -----------------=--- T J (Draw.existing.ancl required addition on reverse side) I hereby certify that I have-piepariA 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. dome owner or licen- sed agents signature certifies the following: ' "I certify that yin the performance of the work for which this-permitAs.issued, i shall not employ any person in such manner as to become,'subject to Workman's Compensation laws of California." Signed -•.................. .... ........ ........ ... ==..................... Owner R titleip 00 ` BY ........ -- ....-. -._.............................. ..................................... 4 (If.ot t an owner [ '• FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........4..... ---------------------------------------------------------------4 v... •.. ......� ------ -- --- - ------ ----- DATE _..�.... �"--- BUILDING PERMIT ISSUED ....................................................... .KY •-•-DATE ..................-------•........... ADDITIONALCOMMENTS ----•..................................•----_............-- .................................................I........................... ...................................... .. i --.-.......-•-•-•--------------�..� ...................................................'?!............ ^...' -•-•--.......-y---.._................................................... .-.,.......... ............................................... .._...... -_ .. .. .. Final Inspection'by: ---:...--•_-_-• t Date ..-��' 2 ' >� ..•-- •••-..... ---•-•......•--- •--•-•............... ........-•---------•-•-•-- SAN•JOAQUIN LOCAL HEALTH DISTRICT I E. H.13 24 1-�,68 Rev. SM 7/72 3 X