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7. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - 73—// ....... Permit Na- ----------------- ---• (Complete in Triplicate) .......................................... ...............------------------ ................. This Permit Expires ] Year From Date Issued Date Issued .......-X3--73 Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: Fes.. ,�[ ..._......CENSUS TRACT .... .'.7. JOB ADDRESS/LOCATION ,:_.... ?.. ..-•- - -- _-'............... �.. Owner's Name ...... a--=---- -----: .........Phone Address .. f..... .......6. 7 LI.,Er�......... City Contractor's Name Q l - ......... .............................................License # --_-..--_-..---------- Phone ---- .......................... Installation will serve: Residence 94(partment House❑ Commercial OTraller Court Motel ❑Other ......................... .................. Number of living units:_.:1..... Number of bedrooms ..:....Garbage Grinder , Lot Siz ---- j Water Supply: Public System and name ...............................�...---••'""�"•�--------t�1...................•........-..................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay '❑ Peat❑ Sandy Loam Z31, Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill 1lbterial ...._..._... If yes,type -_-------------------- -- (Plot pian, showing size of lot, location ofsystem 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 ] Size................................................ Liquid Depth _.-.------_----_---_.- � �.� Capacity ........ Type .................... Material------------.-------_ o. Compartments :..................... C � Distance 4o nearest Well ..................................Length of each line..--....-.........:........Foundation ...----. _... ........ Prop. Line ..:.__.:-,......__---• - ' LEACHING LINE [ ] No'of Lines ----------- ___._____ g Total Length . D' Boz Ty Filter Material .....Depth Filter Mat ria) ....R....... - ' -- «- Distan'A to nearest: Well Foundation Property Line - --, . .......•. - I •' ._. Number ..............�, Rock Filled Yes No SEEPAG 'P1T" =h rUe"th ( � P ............. Diameter ❑ �❑ I Water Table` Qept ------------------------------- Distance --------- --•----- -----Distance to nearest: ell _ .. RFowndotion ----- -- ---- Prop Line --------•---_-----_- 4 REPJ�R/ADDITION{Prev. Sanitation`Permit# .....a..................................... Date ......... .. ............. } Septic Tank (Specify RequirerreV * "= =""�"�" '"` Disposal Field (Specify ,Requireme ' (�v--•._.. � f ._f.nts) � Y F^� i 1 3 ....._•_•__-__ ._� ................ ........__..�...--_.. ..... •_____-..._____...._...' .................................................... .................... j ' x .. {Draw existing and required addition i hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin 1 County Ordinances, State Laws, and Rules and Regulations of the San}Joaquin local Health District. Home owner or [icon- sed agents signet re certifies the following: s "I cerci at i e pert r rice he work for which this permit Is issued, shall nohemploy any person lay such manner as to co ject fo kmanCompens tion laws of California." Signe ,.. ...... ..------•---••--••--•--•- ......... Owner t BY �.............. .� ................:........... -----------••....... T`1&0.. Title ----------------------------------------------- (If other;thon owner) FOR DEPARTMENT USE ONLY ..................................APPLICATION ACCEPTED8Y l1W .� DATE ....G .-.. -�• ~.� BUILDING PERMIT ISSUED .:.f.;: DATE ............................................ ...-- �...t.,__......- ADDITIONALCOMMENTS .... -- . ....................................................................................... ... �-, - ........... ...................... ......................... ..:. ....................... •---•-----••--......----•-----...-----------............••••._............... _.... e - ................................. .........•---....-----••--.. .... ........... .. --- Final ins ecti.on .. .. .^�.! �.... _ � -- -- -" ........................ ......... ..Date ........................................ .... SAN JOAQUIN LOCAL HEALTH DISTRICT A 1.3 24 E. H. a- b8 Rev. 51,c1_._` _ 7/72 3 M