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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �3 CVPermit No- --------------------- (Complete in Triplicate) - -----=----- ---------- ---------- Date Issued 0y1'73._ ------------::J This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made'in compliance with C ty,:Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC � �J-----��-�- ----` - - - ,;,� - CENSUS TRACT --4-47_---------•- 1. Phone------------------------------------- Owner's Name --- -------------------- ------------ - ------ Address ---- f1f --T--------------- - -_� �'--3--- �---=---- ------ City ---- r I License #/�f-' Phone Contractor's Name -------- "'"� `--- --------------------------- I z Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court l❑ I Motel ❑ Other ??� �" -, - Number of living units ----- Number of bedrooms ---'_1V".Garbage Grinder ------------- Lot Size ---- `7--------- , .- � - (� Water Supply: Public System and name ---------- --- ------------------------------------- ------------------------------------- -------Private Peat Sand Loam 'Clay Loam Character of soil to a depth of 3 feet: Sand'❑ Sift❑�.Cldy ❑ ❑ Y ❑ Hardpan ❑ Adobe ❑ Fill Material ---------- If yes, type ----------------------------- P (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,) s ! i v' PACKAGE TREATMENT [ a ' SEPTiC TANK - Li �j Size 'r 'z� quid Depth --- -------------- PACKAGE ---- - 6 �X- Type ^-�J--- Material--- t '-�� No. Compartments ------ .......... Capacity�'�Qa-- Yp i Distance to ne rest: Well ----------- - ---------------Foundation v_ ------ Prop. Line ---.- _T'=----- .aro LEACHING LINE [r] No. of Lines --------- �--------- Length of each line._------..-''_p�-_ Total Length ,_1�9P ----• rr r� D' Box .. ------ Type Filter Material _ -- s�-- -----Depth Filter Material __-�.�----- ----------------------------- Distance to nearest: Well ------- °- __ ____-- Foundation --- -U.__ __---- Property Line ---5 ._.=•--- ,' SEEPAGE PIT [ Depth 1 ----_--`__ ( Number ----- — Filled Yes � No i❑ 3 1 o Diameter I Rock Size ----- WaterX ` Table Depth ------------------ jI 0 Foundation ._.__�n ---- Prop. Line ------ o nearest: We - REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date --------------------------------- 1 ------- Distance aI ------------- i Septic Tank (Specify Requirements) -------------------------------------- ----------- ----------------------------- ---------------- ----------------- -•------ Disposal Field (Specify Requir"ements) ------------ ------------------------------------------------- - --------------------- ------------------------------------------------------ -------------------- k ------------------------------ - - ---- - :� (Draw existing and required addition on reverse side) r I 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: f "i certify that in the performance sof 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 .- ------ Owner __ - ------ ..¢ - Title - �-��f-d4_- ---- ---------- ---------------- (If other than owner) FOR,DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY =---------- -------------------------------- DATES - a - -------- - -- - - BUILDING PERMIT ISSUED ---- -----=----- ------------ ----------- ----------- -------- ---------------------------------DATE ------------------------------------------ ADDITIONAL COMMENTS -------- ------------ ------------ ------------- ---------------------------------- ---------- ------------------------- --------------------------- ------------ ------------------- --------------------,--------------------------------------------- 1 ----------------------- ----------------------------------------------------------------------------------------- ------ ----------------------------- - --- ------------------- -- ___ _______ ------------ - Date � ----------------- Final Inspection by: --.- - --- r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.