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I� 1 I'FOR OFFICE USE: APPLICATION OR SANITATION PERMIT ----------- --=`---------- ------------------- Permit No. . {Complete in Triplicate) 7.3 i - Date Issued ��---_--._ � --------------->------------------------------------------_ This Permit Expires 1 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 isV,? made in compliance with County Ordinance No. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATIO / °�`lie --- CENSUS TRACT Ow"per's Name ------- -1--- � - Phone Address ------- ------------ --- ---- -------- City ------------- Contractor's Name __-_- -,--. - --- -- - _-- --------License # .- �-- Phone _ �s3-' 1 Installation will serve: Residence Q0 Apartment House,E) Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- i j/ Number of living units------------- Number of bedrooms _J------Garbage Grinder ------------ Lot Size -1 - -- T'"s�Q---------- Water ------- Water Supply: Public System and name ----------------------------------------------•---------------•--•-------------------------------------------_Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom .❑ 2 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,) PACKAGE TREATMENT [ I SEPTIC TANK [ ] Size_. _: °_V j/ --1V--------- Liquid Depth --�e.-------------- �i ' Capacity _/Z06)-..-_ Type, ,rPe__XA/___ Material �rY -- No. Compartments �_______________ � , Distance to nearest: Well -----6-------_---_--------------Foundation --- ----------- Prop. Line -__- _i--------- Distance LEACHING LINE [ j No. of Lines ----..,.�------------- Length of each line---- �rJ-_---________-__ Total Length .�l�-. ...---.-_.. D' Box ___ ------ Type Filter Material I,y-� u ! _Depth Filter Material ---�e-----__--------------- --------- Distance to nearest: Well ----LQ-------------- Foundation ....AD---------____ Property Line ._-RC1-_-_---------- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------ --------------- Rock Filled Yes ❑ No C] Water Table Depth ------- ----------------------------------------Rock Size ------ - ---------------------- Distance-to nearest. Well ----------------------------------------Foundation -------------------- Prop. Line ------------------_- REPAIR/ADDITION(Prev. Sanitation Permit# ------- ------------------------------------ Date --__-_--_--_-_----------_-____-_-_) Septic Tank (Specify Requirements) ------------------- ------------------------------------------------------------------------•- ---------------- •-- ------ DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- (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 f as to become subject to Workman's Compensation laws of California." 4 Signed'` ------------------------------------------------ Owner BYC�z -�-�� ----- -- / :------------- ----------- Title ------ -- ---------------------------------------------- --------------- (If other t n owner) FOR DEPARTMENT USE ONLY z �3 .23 APPLICATION ACCEPTED BY -------�' �-� ---------------------------------- ------------------- DATE -------------------•--------- BUILDING PERMIT ISSUED ------------------- ----- ------------------------ ----DATE -------- ---------------------------------- -- -------------------------------- ADDITIONALCOMMENTS --- ------------------------------------------------------------------------------------------------------------------------------ --------------------------- --------- ------------------------------------------------------------------------------------------ '---- ------------------------------------------------------------------------- ----------- ----------------------------------------------------------------------------------------------------- I ---------------------------- - ---------------=------- Firial Inspection by: ------Date -- i SAN JOAQUIN LOCAL HEALTH DISTRICT '" ` E. H'. 9 1-'68 Rev. 5M