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` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------- --------,•--------------------- s- Permit No. 73- 35 [Complete in Triplicate) 7 --------------- - --------------------------------------------------------- _ �. - -----------------------------------------_---------_-__-- This Permit Expires 1 Year From Date Issues! 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 withp County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ........ ---------------CENSUS TRACT ------------------------ �t1r �� t_► �i�t- cf ----------------------------------------- ---------------------Phone - _fv -------- Owner's Name __- ___. ' Address ---------- ---1-0---- r ' --------- ------ City -- ------------------------•-------------.= . Contractor's Name --------- , C.. -- cc.l��_r*----- ---------------------- -----License # A740��'-k--- Phone _ _a = Installation will serve: Kesidence j�3Apartment House-❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number ------------------------------------------Number of living units:---/-___.__ Number of bedrooms __:3__p-___Garbage Grinder, c7_._. Lot Size` `_ ---------------------- Water Supply: Public System and name Characterof os �1-toa depth=of-3`feet�S-�---i-d"'❑�itt-❑Clay ❑�Peafi`❑—Sandy-Loam �"'Cfay---i-m--a-.mPr-i❑va"t e Hardpan 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.) NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I I PACKAGE TREATMENT ( ] SEPTIC TANK'N Size--------6}s-6-1 g------------------------- Liquid Depth � O --�-------------.----- Capacity -------- TypeMaterial_--_ No. Compartments _' ---_---- _...... ',►�\`� / l . Well j�v- ___ ----------------Foundation -x[.42-! — ----------- Prop. Line _1 --------------- LEACHING LINE [A NoDist of Lines ance to nearest: eLength of each line------j_tW___._.____._ Total Length o-2_ ________________ D' Box _ _ -- Type Filter Material __ tF__-- --Depth Filter Material -----------------------------------------•- T --/Il ---------_-- Property Line—/_4!__________________ SEEPAGE PIT �(� Depth ce t nearest: bialrrseter _ _________ Number _._________:—---------- Rock Filled Yes No i❑ Water Table Depth `' --------------------------------Rock Size J :A------------------ Distance to nearest: Well __--- -------------------------Foundation ___/ Prop. Line ---------------------- REPAIR/ADDITION _________.___..REPAIR/ADDITION(Prev. Sanitation Permit#'.-- --- - -------------------------- Dcife ----------------- ---------- -) Septic Tank (Specify Requirements) ------------- - ' ' ' I-- ---------- 1 ---- Disposal Field (specify RequiremeFits)1=---------- 'r1%--------------------------- ---------------------- ----------- -rt - - -----------_-----------_--------- --------------- _ r.___,'__ _____ _ _________________________________________________ 4 �f _ --------- � II ______________________________ __._..________ ____.------____._____________-`-____________________-_...__________________________________________.____________ (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 "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." I Signed --------------------------------------------------------------- ---------- Owner By ------------------------------ ----------------------------------------- ------------------------------ Title -- --.------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY =------ ----- --------------------------------------------- ---------------------------- DATE ------4 ------ ------ BUILDING PERMIT ISSUED .:-------------------------------------------------------=-- - --------- -- ' =-------- ----------._ DATE_------•-----------------------•---_ ADDITIONALCOMMENTS -------------------------- ------------------------------------------------------------1--------------—----------------- ---------------•-•------ --------- -------------------- - -------------------- --------------------------------------------------------------- ------- ----------------------------------- - -------------------------------------------------------------------- ------- - Final Inspection by: -- - -- -- ----------------- - ----Date --- ---gip' ` SAN JOAQLIlN'L&AL 'HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M