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FOR OFFICE USE: <br /> APPLICATION•�FOR ��ANITATION PERMIT <br /> ----- ------------- ---�- - � Permit No: ._73.-'_�4�`. <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued -� <br /> Date Issued P--"6'__ <br /> _ _ _. <br /> ----_-- ------------------------ __------------- -_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION U:----Y_Ylo-O-r.e.-------N--------------------- -CENSUS TRACT -------------------------- <br /> Owner's Name --- a- ------- Q.r-r-�---------------------------------------------------------------------------Phone 1r'= -------- <br /> rU. -L-c-J�a= -=i1l- ___-- p ----- City Address ----- _t, tAk,,-----------License # __S1VI <br /> V <br /> -t--- PhoneContractor's Name <br /> Installation will serve: Residence_[4_Apartment House,❑ Commercial :❑Trailer Court ;0 <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:----I-__---_ Number ofibedrooms ----J..Garbage''Grinder ------------ Lot Size ------42- _ ----•---- <br /> Water Supply: Public System.and name ----------'----------------------- ---------------- ----------:-------------------------------------------------Private 2r <br /> t. <br /> Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam .Pa Clay Loom .[7 <br /> •- Hardpan"❑°- Adobe ❑r FiII�­Material------- ---- If yes type.------------------: <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> Lw. w.Y <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT 0" SEPTIC TANK- Size_____ _ f --� 4 <br /> �,r�'--�1------=Y-10 -" -------- Liquid Depth - - __...------- <br /> ._ <br /> Capacity __�f'� a----- Type -- ---- Mate-rial_j�Q' No. Compartments ----�__....._--.. <br /> Distance to nearest: Well -- ----- _=D__ -._.-_____ V <br /> � _Foundation __./_,�___________- Prop. Line _�-�___-._..__ V, ; <br /> LEACHING LINE Q(j No. of Lines -----9------------- Length of each line-----%DQ------------- Total Length :_ _Q_Q.r,_ ` <br /> 'D' Box ---!------- Type Filter Material ::__= ________ pth`.Filter Material;_.___ _ i, <br /> De �� -- -------------------M <br /> Cl Property Line <br /> SYnT�S Distance to nearest: Well ---1;�-U___------ Foundation ______ _________________ <br /> SEEPAGE X- Depth -----/_0-------- Diameter' _ __ Number ------- Rock Filled Yes, No CI <br /> /r <br /> Water Table Depth -----------------��------ -------------Rock Size ------�----- ------ <br /> --------- O <br /> Distance to nearest: Well -----Z�0_-e)------------- <br /> _.......Foundation ____=5�v-_ -_ Prop. Line .....-- 0 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ---------------------------------- P <br /> Septic Tank {Specify Requirements} -----------------/1 °-- L <br /> �_�CJ -------- --------------- <br /> Disposal Field (Specify Requirements) _--------Pq --- --- ---- ------ - ----�--i- --� -- -- U--Yn ----------------- <br /> - e k <br /> ------------------------ <br /> - <br /> -- - -- ---------------- - = - - _ — --�- .' <br /> '" ' -------------------------- <br /> '(brow existing and required addition on reverse side) <br /> I hereby certify that I have-prepared this application and that the work will be 'done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcen- <br /> sed agents signature certifies the following: <br /> "I certify that in the pserformance of the work for which this permit is issued, I shall not employ any person in such manner" <br /> as to become subject"to Workman's Compensation laws of California." <br /> Signed : --------- I----------- --------- ---------- ---------------------- Owner <br /> 0 <br /> BY ------- - - Title <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - --- -- -------------------------------------------------------------- DATE --- -------- <br /> BUILDINGPERMIT ISSUED _-'- ------------------------------------------------ ---------------------- ------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ---=---------------------------------------------------------•--...----------------------------------- ----------------------------=---------- ------ <br /> ------------------ ----- ------------------------------------ - - <br /> --------------- ---------------------- - ---------------------------------------------------------------------------------------------------------------------- --------------- <br /> --- ---- ---- ---- - :=' - ---..,--,.__�-_ - ---------------- <br /> _.,_ --- -- <br /> Fina! Inspection by. <br /> '' t -----------------.Date (__--- ---------- <br /> -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />: <br /> a <br /> E. H. 9 1-'68 Rev. 5M <br />