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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No. ..................... .................................................. (Complete in�Triplicatelo ....................................I................. x � Date issued ---77..3 ".73 This Permit Expires 1 Year From Date issued ...... Application is hereby made to the San Joaquin Local Health District for a s,permit to construct and install the work herein described. This application is.made in compliance with County Ordinance No. 544 and existing Rules .and Regulations: rtt9.�SA. CENSUS TRACT JOB ADDRESS/LOCATION .3.J�_....._,�� .......................... _...� , _ .Phone �` Owner's Name I N_ .1.a......... T...,.:_.... ...{...-- ........................... _. Address ..._..... r. c.�. ` .. .--- • r City ' - ................:........ r --- PhoneContractor's Name �:.... i�rt2�5.�:-� :� f P i Installation will serve: Residence Apartment House Commercial ❑Traller Court ❑ Motel'El Other •• ------•-- ....... . Number of living units:..---- ._.. Number of bedrooms-A.....Gorbaoe Grinder ............ Lot Size _..-Q. ' ........... { ( Private �..�—• - Water Supply: Public System and name ...--... ...... -•- Character of soil to a depth of 3 feet: Sand. . Silt❑ Clay ❑ Peat.[). Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 'C3 Fill Material+... ...... If yes,type ....-------•--•-------- (Plot plan, showing size of lot, location of, system in relation to wells, buildings,tetc. must be placed on reverse side.) ` ( NEW INSTALLATION: (No septic tank or-seepage pit permitted if .public sewer is available within 240 feet,] I PACKAGE TREATMENT ( } SEPTIC TANK I ] Size.:..................................•-------:._- Liquid Depth ._..--•---•-•--..._.,...._ w Material Na. Capacity Compartments ...:............ ---- . .Foundation .. prop. Line ...................... � Distance to nearest: Well ••-"--"'-••"'-�-� LEACHING LINE [ ] No. of lines---------.----------...-. Length of each line_______________............... Total Length .............4.............. Type Filter Material .Depth Filter Material ................Sax yp •-•-•--••---......_ a Distance to nearest: Well ........................ Foundation ............ Pro.-•--------- P rtY Line ........................ SEEPAGE PIT [ Depth Diameter Number ............................ Rock Filled Yes ❑ No 0 Water Table .Depth .........Rock Size ................ Distance to nearest: Well -Foundation ... Prop. Line ....._...._..---•----- ---••- ----""•"'----' REPAIR/ADDITION(Prev. Sanitation Permit# .......--•••-•• .. Date ) ..................................... ....__ ................... ............ Disposal Field (Specify Requirements) ~ ---------------•---------•----------- ----------------------------------- ---------.._.--_._.--------••- -----------------_...-------------------------------------------*--- ----.--- --•--- ....... .... .......... ------------- ---- (Draw existing and required addition onreverse 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. Home owner or liven-- sed agents signature certifies the following: . arson in frauci+ manner °'I certify that in the performance of the work for which this permit is issued, 1 shall not employ any p as to become subject to Workman's Compensation laws of California." Signed .:... .................•--...----• ---•------. Owner e .... ..........: Title r....... t ...................... .... (if other than owner) R DEPARTMENT USE ONLY DATE 7.r 7-•- ..... _-- [ 3 APPLICATION ACCEPTED BY ...... ... ... ... "" BUILDING PERMIT ISSUED .....- DATE :.._...- -----•--••----- .....- ADDITiONAL COMMENTS ........................... ..................•---•---...---......... •--------------*..._....._....-•---.- --........... . ....-•--........------- ------_.�----:----------------- :....:.- j'... --•---•• . ......_.._.-- _. .' r .. Date A Final inspection by: _....-•---v -.... �--'�-'.----�"� - • r. SAN JOAQUIN LOCAL .HEALTH -DISTRICT .•�._ .. 7/723 , I ,. 13 24,, •,&a o_ +CAA