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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------------------------ Permit No. ----73--�f� (Complete in Triplicate) - ---------------------------------------------- -- ------- This Permit Expires 1 Year From Date Issued Date Issued __ __lv'73 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 _024 - _------- f, -------V---------------------CENSUS TRACT _' --------------- Owner's Name --- . h - Phone -------------------------- Address5_�'7-�J?--- ---- ------------------------------- City - ----------- - ----------------------------•--••-- ' Contractor's Name --_ ------------------------------------------------------ ----------License # ------ -:-------------- Phone -----------------------_----- Installation will serve: Residence,] Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other Number of living units:___------ Number of bedrooms ________Garbage Grinder ___ Lot Size _d °__ :-''________•_____________ Water Supply: Public System and name ---------------------------------------- --------------------------- ------------------------ ------Private] Character of soil to a depth of 3 feet: Sand'D Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,® 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.) t NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK.. Size___� _'�"___ d-_ -- -________ Liquid Depth ___ �______________ capacity 42_00------- Type _ - Material---407?�-------- No. Compartments _:�w............... Distance to nearest: Well __•' O---------------------------Foundation --I--a�____________ Prop. Line ---VIO-.._________ LEACHING LINE No. of Lines --a�________________ Length of each line-_- _4!7 --------------- Total Len th ___-_0 -07l-_----_-_•-- 'D' Box _- Type Filter Material _/ c_�•------Depth Filter Material _--l!________________________________ R Distance to nearest: Well '�10--------------- Foundation -/_d..____._________ Property Line _± i SEEPAGE PIT .] Depth .002.5---------- Diameter _ - _�'� Number ----------.'X------------- Rock Filled Yes.* No 0 f Water Table Depth ------- - ----------Rock Size-- ----------------------------- Distance " Z Distance U to nearest: WellfQ"�_'___________________________Foundation __lQ_______-__-- Prop. Line ___r._.......__.. o� REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------ -------------_-•- ----------------------------------------------------------------------------------------------------- - - - w - --------------------------------- -- (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. Nome owner or licen- sed agents signature certifies the following: "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 t Work n's pensation laws of California." Signed _ ------------------------------ ------------ Owner BY --------- --- - --------- Title --------------------- ------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------------------- - ------------------ DATEr _l7�� BUILDING PERMIT ISSUED ------ ------DATE ------ ' ADDITIONAL COMMENTS __ � s-_ -------------------- -------------------------------------- ---------------------- ------------------•-------------------------- -------------------- --------------------------- ----- ------------ - ----- -- ---------- -------- - --- ----- ----- - -- ---------- --- ------------------- ---- ------------------------- - ------ -�-- ------- ------- Final Inspection by: -------------- --,------ ----------------- ------ - - ---------- ------------- e ------------------ - 3 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �