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FOR OFFICE USE: APPLICATION�LFOR SANITATION PERMIT Permit No, (Complete in Triplicate) D ----------------------------------------------- --------------------------------------------------------- This Permit Expires ] Year From Date Issued Date Issued 14-7.3 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 ADDRESS/LOCATION ad _!. --- ------70A --- CENSUS TRACT -------------------------- g Owner's Name ------ 3_e�(Y_t--------wev o-1v----------------------------------------------- --------------Phone .._ r - Addressi._G'. j, 4 City _ fu 6 ---------------------------------•--- .�__.._.�.. --�.„..,_- -- . Contractor's Name ---"--------- -------•- ------------------------------------icense'# ' Installation will serve Residence Dd Apartment House❑ Commercial :❑Trailer Court 0 " Mote! ❑Other _________________ Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size _._'.4 I�V_ng<_--s-._-..__-- Water Supply: Public System and name -------------------------- ------•----------------------------------•--------•--------------- -------- --------Private ❑ Character of soil to a depth of 3 feet: -Sand'❑ Silt❑ Clay •D4 Peat❑ Sandy Loam ❑ Clay Loam [] Hardpan ❑ kAdobe ❑ Fill Material ------------ If yes,type _____________ ______________ (Prot 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,) r� PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size__�� _.-X rly.�-.kV Liquid Depth -__� ------_-_--- 1 Capacity ./6VV_____ Type "-�� Mafierial______________________ No. Compartments '- { .r t Distance to nearest: Well ......� ._____--_-___________Foundation _ _ ----------- Prop. Line Q ----__ W i LEACHING LINE [ ] No. of Lines _.__ ___ Length of each line__.._ 6____________ Total Len'th _342-A10........_.. 0 - ----- 9 � R7- 9 D' Box ----- ___.- Type Filter Material Depth Filter Material ___ 1�-� ________________.__-____-_ � Distance to nearest: Well ------------------------ Foundation ---------_------_-------,_ Propertyk Line __________________.__.__ SEEPAGE PIT [ 1 DepthTable Depth Diameter -__ Number ----- __ _____________ Rock Filled Yes C] No [3 Water P ---------------Rock Size ---------------------------- r �, Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ____-____-________..__ REPAIR/ADDITION(Prev. Sanitation Permit�# ____________________________________________ Date _______-_-__._________ __________) ! � I a :r Septic Tank (Specify Requirements) ----------------------- -------------------1-- - l Disposal Field (Specify Requirements) ----------------------------------------------}------- -------- --;------------------------------ j'. __________________________________ ________________________________________________________________________________1------- ----------{ F i_-_-_.--------______-__________�___ r ! ----------- `` '----- f ; ------ -------------------------------------------------------------------------------------- ---------------------------- (Draw e)eisting and required addition on reverse'side) I hereby certify that!1 have prepared this appftcation and that the work 11 be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Jo ac�um Local Health District. Home owner or licen- sed agents signature certifies the following: �`----- -~----�" "I certify that in the Oerformance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject} eworkan'so+ pensation laws of California." Signed _'&------- - -- - ::_ _ f .Owns BY - ------------- -------------------.-Title --- --- --------------- (If other than owner) i j FOR DEPARTMENT USE ONLY ) APPLICATtONw-ACCEhED-BY-_ a_ j ---- --------- DATE_. ... � .... -._..- " - =-*------- BUILDING PERMIT ISSUED - =-------- ---=----------------- - ----------------------- -------DATE ------------------------------------------- ADDITIONAL COMMENTS ;---------= '= - i -. ------------------------------- ----------------------------------------------------- - ----- --- -------------- .. ._._ -- - -------- _________.__.___._-._._________.__--__- __________�__-___-_____-_._______________-__--_____.__-___-______--_-_______ _ -�-_--------------- I __�-� ,--_. _LJ � __-___--_-'_M__--_-_.___. Final Ins ection b (J//'r'Y}}� P Y = --.Date - 1_ �2 SAN JOAQUIN LOCAL HEALT STRICT E. H. 9 1-'68 Rev. 5M i