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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .... s 3 (Complete in Triplicates Permit No. . .........3.... �.�.. �............................ Date Issued .9::,,4�-.73. , ...... This Permit Expires 1 Year From Date Issued 4 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: cc-- JOB ADDRESS/LOCATIO .....dam_. . .....CENSUS TRACT Owner's Name --........ ..._... -- • -------------- ------- •.Phone�!�� '.�a_7��...--- Address .............. ........ ._0........... ... ._.1 �._... ... City ..... . . ......... ....... k cc Contractor's Name ............ ............... ._ __..d ?-t. ........................License Phone:._' ,,�AZ. Installation will serve: Residence'or-Apartment House❑ Commercial QTraller Court 0 Metel ❑Other ........................... ............... Number of living units:...../.... Number of bedrooms ....Garbage Grinder ............ Lot Size --------0994..-+... .......... Water Supply: Public System and name ............. ......................_: 4 :- .. ....... rivatev......... --..::---..........-... ........ r Character of soil to a depth of 3 feet:J Sand O. _Silt❑ - Cloy ❑ ..Pegt C] ' Snndy-loom 0 Clay loam ❑ .Hardpan ❑ Adobe`s' Fill Material ...... If yes,type ---------------------------- i (Plot pian, showing size of lot, location of-system InL relation to-wells, buildings, etc. must-be. placed on reverse side.) NEW INSTALLATION. {No septic tank or'seepage pit perk ter]•if public sewer is available within 200 feet.} , . [ I ] nv Liquid Depth PACKAGE TREATMENT SEPTIC TANK � Size-•-•...................................... ........•......•.......... x, Capacity ..... .............. Type .................... Material..:.................... No.-Compartments ......................%P Distance to nearest: Well ....................................Foundc.tion ...'..:..'.::....,..':Prop. Line ..................... LEACHING LINE [ ] No. of Lines ........................ Length of each line....._._..._.._......,.f.._. Total.Length ........................... D' Box Type Filter Material ._...................Depth Filter Material Distance to nearest: Well ... Foundation ..............Property. Line-:....:.................. Diameter Number:.;._.= ...::............ Rock Filled Yes No SEEPAGE PIT [ ] Depth ................ ....:........... ❑ 0 Water Table+Depth ............ ...................Rock"Sizew.........:.............. .-•---• Distance to neoresrWdil.�_ ':.:" `"`.......................Foundation ....................,Prop. Line ....._._.._..........N I - REPAIR/ADDITION(Prev. Sanitation'Permit# f.-....... Date ......]` ro Septic Tank (Specify Requirements) ` Disposal Field ISpecify Requirements) ;...,.-..... ._._..... .__.__ .i .fEjl........ .........................• ............................................................. ...:.17...33.......X...4 . ........... �c s,�*-x._.. -�. . ........................................................................................... --••••......---- - ----•• ------- ----------._...--. {Draw existing and required addition on reverse side} ' I hereby certify that I have prepared this;application and„thii 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 ! - "1 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." Signed ..... j ...:...,Owner I-,' .. t F.. �---�__...............�.�.. ..By ......... ........... .... . ....................... .......... . .......... Title .... (If of a than owner) ,FQR DEPARTMENT USE ONLY APPLICATION ACC PTSD. BY ..-• -- .. .. :. .......... ................................:.........::......:........... DATE '..... ... .. ... ............. # BUILDING PERMIT ISSUED ....:.. . .. ..:. ..... .. .........(I DATE .. ....................- ............ ADDITIONAL COMMENTS -----1 ( .. 1. .../h�z.5 ... Re.....� �! f?y?. (........?.... :........................... ----------------------------------....................................................................................................................-................................................................... .............. ....... ......---------------------- .. . .._ Final Inspection by: ...... ...... ... Date ..............._._ ...............................•................... . ... 1.. SAN JOAQUIN -LOCAL HEALTH DISTRICT F C F. H.13 241-'G8 Rev. 5M - t _ r- - .�'`� " 7/723 M