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F6P OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . 73—_....... .......----•...................•..........._. ...._.__. (Complete in Triplicate) ..........`...............••-- P 3 77-�3--V ......--�............ . Date Issued ..l.....:.......... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with Comity Ordinance No. 549 and existing Rules and Regulations: :� . JOB ADDRESS/LOCATIQN ..- Z' ....:.0 Ph .CENSUS TRA N fl � SIC ....:.....................•••_ one Owner's Name .............. ......_.�...------------••-----•- r t C slts�, -C,V-% ....... .. Address ..... s ,ri ca ._..:. ----"--•---•--• ..... city .. Ph...--. + . �a ... . �Att sn>:' ..` '.d4: _ '._.License # `� '�` :_. one' Contractor's Name ........ .. . . ..•----- - -- - .. .. .... .. t......----- Installation will serve: Residence [Apartment House❑ Commercia#❑Trailer Court ❑ ¢ Motel ❑Other •-- •................. -- E,�x f ..............: Number of livingunits:...... ......Number of bedro s ...-�.:.. Garbage Grinder .__. _..-_ Lot Size ...._.__._.....-... ❑ � x Private Water Supply: Public System and name ---------------- �'- �'�`' ................ --------------:..:...-•--._...------...... Character of soil to a depth of 3 feet- Sand❑ Silt❑ Clay ❑ Peat C1 Sandy Loam ❑ Clay Loam ❑ Hardpan O Adobeq!j. Fill Material ............. if yes,type ............................ (Plot plan, showing size of lac, location of. system in relation to wells, buildings, etc, must be placed onreverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) . Size--------•---------•---------•-••••-..---• .. Liquid Depth ..-_._... ....... PACKAGE TREATMENT [ I SEPTIC-TANKTj nts _..._............,...._ %Y- ....... -• No: Com artme Capacity ..... ...........:.. Type -•---.. ....-----. Material I ..� Foundation ••• Pro} . Line ...................... Distance tok nearest: Well ••..... " """ 1 Length of each line.-----_---• Tota# Length ............................ LEACHING LINE No. of Lines 9If D' Box .Type, Filter Material .............Depth Filter Material ........................... ' l Dista nce 4o�nearest: Well ........................ Found tion _------�--:.....---• Pro artY L lne Dept mNumber ..............•:------...... Rock Filled Ye.s........:....N..o .(3ae SEEPAGE PIT [ ynn :..I.............:................Rock Size ...,. Water Table .Depth .:.. ....#.--�-------- -----Pr Line ...................... _ + Distance to nearest: Well ........................................Foundation'...-- --.------ k REPAIR/ADDITION(Prev. Sanitation Permit# ....- ................. •--- Septic Tank (Specify Requirements[ ............................................................. C r 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�loaquin Local Health District. Home owner or iican- sed agents signature certifies the,following: "I certify that in the performance of the work for whichthispermit is issued, I shall not employ any person in such manner as to become subject to Work an's Compensation laws of California." Signed . ............ ...........................@ 4 . Owner • . By .................. . xitle- . t R........................ . ............. (If other than owner) FOR DEPARTMENT USE ONLY ....�f APPLICATION ACCEPTED 6Y "f-... - ..... - DATE DATE BUILDING PERMIT ISSUED ---•-------""" ADDITIONAL COMMENTS s . ---...--_......................................•--..........-. = 5 ....... :.._... ........ ...................•------..---• . .............................. ..•- . ................ ..................... ...........Date - • Final inspection by. •.----- •- --• - -• - .. . ,FSAN.JOAQUIN -LOCAL, HEALTH DISTRICT - _ 7/723-M