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FOR OFFICE USE: ';_ APPLICATION FOR SANITATION PERMIT --------------------------- (Complete in Triplicate) Permit No- -----Z3- - ----- ----------------------------------------------- =-... ______________________ _` This Permit Expires 1 Year f=rom Date Issued Date Issued _��_�o--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 maclg in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _313_43` -arI�T��-� -------------------------CENSUS TRACT __. ' _`_. r Owner's Name .__'_.-._ F ------�_IJN _ � ---------------------------------------/-"- - ---------------Phone ---------------------------.-------- Address -----------3T-3-4-3-----------F------ -L0 N } - city ---- K_l?� - ---------------------------------------- Contractor's ----------------------------------- -- n - Contractor's Name ------1`�_-. -_ = �d_LLF ' License # ------- - ----- -------- Phone --------------------------•-•- Installation will serve: Residence 2-AIP-O-rtment House❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- Number ----------------------- ------------------Number of living units------ ------ Number of bedrooms -"0-7 -Garbage Grinder Lti/_u___ Lot Size ___ Water Supply: Public System and:name ------------------ ---------------------------------------------------=---------------------Private Character of soil to a depth of 3 filet: Sand❑ Silt[]41( Clay ❑ Peat E] Sandy Loam 0 Clay Lou . Hardpan RT 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK [ Sire-= ------------------------------------- - ---- Liquid Depth -------------------------- Capacity Type -------------------- Material---------------------- No. Compartments --------------------- r Distance Jo neares : Well ----------------------------'Y.-----Foundation ---- ---------------- Prop. Line --_.------------------ 4y LEACHING LINE [ ] No. of Lines ________ ______________ Length of each line-----------------------I-___ Total Length _-_-_______-__---...______-_ 'D' Box t------------ Tye Filter Material ________________-4Depth Filter aterial ----------------------- ....... Distance to nearest Well ________________________ Foundation ---------------- ------- Property Line -----------_--- SEEPAGE _____--__- _.___SEEPAGE PITDe th [ ] p -' -- ----------- Diameter ---------- ----- Number--------------------- ------- Rork Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ------- ------------------------ Distance to neare : Well ----------------------------------------Foundation --t ------------, Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit ____________________________________________ Date ___.�;_jJ___ _________ % Septic Tank (Specify,Requirements) - -----------------------�------- ---------------- - l p c (Spedify am ' 4 - Disposal Field (S eaif Re u�rementsl��._,__ --- c _� -nr --`-------- .........- - ------ c�--:---------�Q ,Y -------- -_ ---------- --------------------------':------------------------------------------------- --------------- -------------------------------------------- ---------------------------- - .(Draw existing an required addition on reverse side) I hereby certify that l have prepared this application ci.nd 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: "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 becor sub' ct to orkma 's ompensation laws of California." Signed ___�-.-____ Owner i By --------------- ----------- ----------- --------------------------------- ------ Title -- ---- --- ---------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY" APPLICATION ACCEPTED .BY ------ 1 `,R ---------------- - ---- DATE ------- BUILDINGPERMIT ISSUED ----------------------- —------------------- ..._----------------------- -------------DATE--------------------------- -------------- ADDITIONAL COMMENTS --------------------___- . = == � -.> — — v \' � e I,-. -- -- --------- _ Final.Inspecti by: Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M