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FOR OFFICE USET APPLICATION FOR SANITATION PERMIT Permit No. -73=_ ----------- ---------------------------- ------ ----- --------------- (Contplewinlriplicate) ---- ------------------- y.. Date Issued ��_`�---73 This Permit Expires(Year From Date Issued 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: � � t CENSUS TRACT JOB ADDRESS/LOCATION -- - ' : L ' Phone � 1_ s l !7 L� C__ L-t-e'2.1�_�---------------- ------------ Owner's Name _____ -- --� ----'------ 4 Cit � � Address --- - Cd � Y �--- - /2��- --------- -- - - -----��--�--.fir` i :--�-��_.___��-!_��•L---�--- --------- - License# 5� 9a/ Phone --- ---------------• Contractor's Name Installation will serve: Residence F1Apartment House-CR Commercial '❑Trailer Court ❑ Motel ❑ Other -------------------------------------------- i Number of living units:_._-------- Number of bedrooms ------------Garbage Grinder Lot Size ------------------ - - Peat Sand Loam ---------- ---- Private [� Water Supply: Public System and name _--____----------------------- Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ ❑ Y ❑ 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,) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,),/ i Size �/d---- ------------ Liquid Depth __7----� --------- - ------.- { PACKAGE TREATMENT [ ] SEPTI C TANK [ ] Z� 6 No. Compartments -------------•----•--• _ f Capacity _f_��----- TYPe�'e--------- - Material_ -- ----- p Foundation _.�.d------------- Prop. Line --6--------•---•- i Distance to nearest: Well __________��--------------- - � LEACHING LINE [ ] No. of Lines ---- -------------- Length of each line-----?d-------------- Total Length:�- - ---••----------- 'D' Box _._ -------- Type Filter Material _ ��---Depth Filter Material ___1 -------------------•- . 1 ------- Foundation .../-9------------- Property Line ��- ---------..-_---- Distance to nearest: Well _-��_ --- SEEPAGE PIT [ ] Depth --- Diameter -----------•---- Number ----------------------- Rock Filled Yes ❑ No I❑ ble Depth Rock Size -------------------------------- Water (� ------------------ - Distance r _Foundation -------------------- Prop. Line ---------------------- Tas 1 to nearest: Well i ---- Date ----------------------------- ' REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------- ----- -- Septic Tank (Specify Requirements) --------- ------------------------------------------------------------------------- -------------- Disposal Field (Specify Requirements) -----------• --------- --------- - ------------------------------------------- ------------ ------------------------------------------------------- ` I _ _ _ ____________________________________________________________________________________ I (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. 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 become subject to W kman's Compensation laws of California." Signe ___. Owner 9 a= ------- -- - Title ----------- -------- --------- --------- ------------------------------ BY ------- (if other than ow er] FOR DEPARTMENT USE ONLY 2-L3-7 3 > ----------------------------------------. DATE ------- -------------•-----•--.. APPLICATION ACCEPTED BY �---------- ----- ---- ----- DATE __ BUILDING PERMIT ISSUED ------------ - � - ---------------- - ADDITIONAL COMMENTS ----r?_ _____�_ --- -------- --- ------------------------------------------ ---------------------------- - --------------------------------- ----------------------------------------------- --- ------ ----------------- Final Inspection b - Date ---10-1.?`? ---- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M