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,,JbR'"AFFICE USE: ...:...................................�:��.2-. . " APPLICAIIOhI FOR S�ANRIicAate©N PERMIT Permit No. .73.T................. 4 (Com lete Date issued 6%.-73 _.._... .._.......... 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 made In compliance with County Ordinance No. 549 and existing Rules and Regulations- JOB ----------CENSUS TRACT ...................:...... JOB ADDRESS/LOCATION ..' ��"�..;..�...--•- - •• --------.... , Owner's Name. �.:_:_;::.... ... ............................. ............... Phone Address ., ._.. .. . ... .. ..... 2sycity '. . ....... .......................... _.... - � Contractor's Name License # Phone .............................. Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number ------------ •---•---•-------Number of living units:....... Number of�bedrooms ___3.....Garbage Grinder ...._.__.... Lot Size -••••--••------•• r �. Private ❑ Water-Supply. Public System and name :................. :..... J. Character of soil to a depth of 3 fee 1' Sand❑ SiltO,, Gay D 'Peat[] Sandy Loam ❑ Clay Loam ❑ ii rdpon ❑ Adobe`4 Fill Material ............ If yes,type ------------------_-------- t ,, l (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,[ 8 PACKAGE TREATMENT [ ] SEPTIC- TANK.1 ]'� Size_ .. . Liquid Depth CapacityType ....... Material...................... No. Compartments ............ ....... Distance to nearest: Well Foundation ...................... Prop. Line ...................... .... ... ' dw LEACHING LINE [ ] No. of Lines ............................ Length of each line._................::....... Total length .................I.......... • . D' Box Type Filter Material Depth Filter Material ............:............. ...........:::... ' ° ...:: Property Line Distance to nearest:�Well :. Foundation _.......___•----• ; SEEPAGE PIT [ 1 Depth .._. ............... Diameter .......... Number .._...."............ :..... stock Filled Yes ❑ No (:jt , Water Table Depth Rock,Size --------------- Distance to nearest: Well Foundation`................... Prop. Line _._.............- REPAIR/ADDITION(Prev. Sanitation Permit�# .-..._.........:............................ Ddte ._.._.............." •...------•f Septic Tank (Specify Requirements) .................. .. .... ........ ............. ...... - _. Disposal Field (Specify Requirements) .--•---•-• �'�... lt�r�.--z ........ ...:. ------------- ------------ ......................................... Q.....�4-�...._ x�-?-....----------------....... ...... .................................................. .(Draw existing and required aclditionron reverse side) I hereby certify that 1 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: - - .1 4 "I certify that in the performance of the work for which this permit is issued, I shall not.ernploy any person In such manner i as to become subject to Workman's Compensation laws of'California." ` Signed ---_........ ... ...._--- f �. .... Owner Own er`:. � ----- - By ---------- Title •------._.... ..................... 4 (if othe t n owner) ]] FOR DEPARTMENT�LiSIE ONLY APPLICATION ACCEPTED BY .......1....��. - _ ..... ::..................... ..............., DATE ._... ...- ..�� . BUILDING PERMIT ISSUED ..................................DATE ............................................................ ADDITIONAL COMMENTS .................................... ..... ....... ---- �. .... .. . D t Final inspection by: ....:.......... . .: : : i- _ ........... a e _ ... SAN JOAQUIN L CAL HEALTH DISTRICT r- L, 13 24`,_'Aa os.. AAA 7/723 M