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Q FOR OFFICE USE: APPLICATION FOR SANITATION `PERMIT 73 -� '7 •--------------------- (Complete in Triplicate) !l. Permit No. --------------- -- ------------- p Date Issued ---------------- ------ This Permit Expires l Year From Date Issue r ------------- j it to and e work Application is hereby made to the Son Joaquin compliance eLocal Health District i tOrdinance Nom549 and existing Rulestalndhlzegulationsrein described. This application is made p 7 11 1 __l Dom* A/ 'C.CI1A JOB ADDRESS/LOCATION CENSUS TRACT Phone -��- -------- -- -- .- ------ " ��UG---- -±--X111.Y!V_S-a-----------------------------------------•-------`- ------ ------ �- COwner's`Name ---- � i - --IVM?o-/r4------------------------------------------- Address -- 1� X_-tL -----------=- l tY a5 -Di City 11 _ " -n2-- Phone _�r3_�_-16�G-- Contractor's Name ------A,�,--�U-,�-�=��------------------------------------------- License # �'+� �� Installation will serve: Residence �f Apartment House❑ Commercial,�:j]Trailer Court �❑ Motel [3 Other ------------------------------- E __________- i Number of living units----j------- Number of bedrooms -4/____-Garbage Grinder .------- -- tot Size rPrivate Water Supply: Public System and,.name -------------------- --- ,1M- Character of soil to a depth of 3 feet: Sand'0 Silt❑ Clay [—I Peat ElSandy Loam Clay Loam ]E]Hardpan E] Adobe ❑ Fill Material _-- ------- If yes,type ---------------- ------- --- rse side.} (Plot plan, showing size of lot, location of system in relation to wells, bui��dings, etc. must be placed on reve NEW INSTALLATION: (No septic tank or seepage pit permitted if public se er is available within 200 feet,] PACKAGE TREATMENT [ SEPTIC TANK'[ ] Size-------------------- i--------------------------- Liquid Depth ---------------------- ------ No. Compartments Capacity Type Material p ,. k ; Distance to nearest: Well --------------------------------- Foundation ---- ---------------- Prop. Line ------•--- - ` P Length of each line----I--------------- ------ Total Length -------------------------- LEACHING LINE [ ] No. of'Lines :, g _° '� Depth Filter Material -------------------------- 'D' Box------------- Type Filter Material --------------- E Distance to nearest: Well _______________-_ ------ Foundation -------------------------- ------------------- Property Line ---------•---------•---- Depth -___ Diameter _ Number � -- ------ Rock Filled Yes ❑ No SEEPAGE PIT [ ] p _______�------ - 11 Water Table Depth Ro�k Size - p E Distance to nearest: Well ____________________ .F0d ndation -------------------- Prop. Line ------- ------- l -------------- ----------------- Date ----------------------------------) REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------- - ------- ------ -- --------------- 11['------------------- ------------------------ ------------- --- -------- Septic Tank (Specify Requirements) --------------------------------- - � �- --------------------�-- ---7�--------------------- Disposal Field (Specify Requirements) --------- i . . ------------------------------------ --------- - ------------------------------- ------------------------- ------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work I . be done In accordance with San Joaquin r County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- 1�• sed agents signature certifies the following: i "I certify that in the performance of the work for which this permit is issue, I shall not employ any person In such manner ` as to become subjec to Workman's Compensation laws of California." Signed ----- �,----'-� �----- - -----------------------------------------------------_-_. Owner _ --------------------------------------- .BY -- -�--------- By -------------------------------------------------------------- --- ------------------------------------ Title ` (If other than owner) i t. FOR DEPARTMENT USE ONLY ---------------------�------ -------- --------- DATE _..-----�--��---�-3- -----------• APPLICATION ACCEPTED BY ------------------ --` r------_- 13UILDING PERMIT ISSUED _.__� ------------------- -----------------------------E)--------------------------DATE ----------------- --------ADDITIONAL COMMENTS ---- �- ----- - ` ----------------------- ----------------- ----------------- -- ------------------------------------------------ --------- ---- -------------------------------------- 1 -------------: ---- Data 3------ -----! Final Inspection b SAN JOAQUlN LOCAL HEALTH ;DISTRICT E. H. 9 1-'68 Rev. 5M