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FOR OFFICE USE:.. APPLICATION FOR SANITATION PERMIT ......................1...................... Permit No. ..73-3s.. ' (Complete in Triplicate) ................................. Date Issued .............................................. This Permit Expires t Year From bete Issued Application is hereby made to the San Joaquin local Health District for a permit tri'construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION-..�,� .Y........ . ....... ....�.., 1 ..........................................CENSUS TRACT .........::............... ' .. � .t![ `s... ..�.. .......Phone..................................... OwnersName -..... •--.. .......... ......................:........ Address /�1... :.... ...��'�• bi• •-•• City , d�L�......................................:..... Contractor's Name .... l ... ............... ... ..-•.-•--........ license #. - �.... Phone .............................. Installation will serve: Residence C] Apartment House-•Commercial ❑Trailer Court 0 / Motel Other ............................ ............... 4 Number of living units:---�P.... Number of bedrooms .,'!l.....Garbage Grinder.............. Lot Size •--••• Water Supply: Public System and name ..Private 4 Character of soil to a depth of 3 feet: Sand D -Silt❑ Clay ❑ '.Peat❑ Sandy Loam ❑ Clay Loam `. Hardpan ❑ AdobtO Fill Material ...... if yes,type ............................ i (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 [ ] SEPTIC TANK ............................................... Liquid Depth ........................:. i Capacity .................... Type .................... Material------................ Na. Compartments .Foundation _... Prop. Line a - Distance to nearests Well ................................... ..........---•---- .._................... S •?'� LEACHING.LINIE No. of Lines .......:::............. Length of each line............................. Total Length ............................ 0 1 S7- 'p' Box ............ Type Filter Material ....................Depth Filter Material ............................................ Z Distance to nearest: Wel! ........_........ Foundation ....-•.................. Property Line ........................ v SEEPAGE PIT [ ) Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth ................................................Rock Size Distance to nearest: Well ..........I.............................Foundation .................... Prop. Line .....................6>1 C 4 REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ] A E Septic Tank (Specify Requirements) -- ............ . ............. _ .._.. ._........_.... Disposal Field (Specify Requireents) .......2... . .....2... - ..... •^ --...e........................................................ jo . ........................ ............... .........................................:................._............................:............................... 6 (Draw existing and required addition on reverse side) 1 hereby certify that 1,have prepared this application and that the work will be done in accordance with San Joaquin j 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 w k for which this permit is issued, I shall not employ any person in such manner as to become ct to man's pens tion laws of California." Sigxted ,� _ ! .a ... .. . Owner By .........................................:........................................:.................... Title ....................................................;................... . (If other than owner) t FOR DEPARTMENT USE ONLY I .............. DATE _.:,��' .....f .—.. .... APPLICATION ACCEPTED BY ..__. .__. .. . ..... BUILDING PERMIT ISSUED .....:.........•-- :........_.. .......:.::_.........._.-.-...........:..::..._.. DATE ... ADDITIONALCOMMENTS ........••..............•--•:.............-----..........---........--•---................_........................-----...........:.....---•--................ .................•--.--------........................----..... .................................................."••- .................._, .................•--• ------ --•- Final inspection by: .. ate c.�L J.... t SAN JOAQUIN L L HEALTH DISTRICT �7 � � .. .. z �4, ..., „- �.. 7172 3 M '