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S FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------- 7��_.�./'� (Complete in Triplicate) Permit No. 72- --------------- ------ This Permit Expires 1 Year From Date Issued Date Issued _ V...... f 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: JOB ADDRESSAOCATION _ _ _ O/____A! CENSUS TRACT ____________-_----.--_. Owner's Name --- 4P,5_�--y�.17 71,11A- --- ----- ------Phone ---------- Add ress ---------------------------------- City r Contractor's Name ./, . _.� �� `5 -- - -----------------------License #1771, __ Phone �,�=_5 ' _. Installation will serve: Residence ❑Apartment House❑ Commercial-ETrailet Court l❑ Motel ❑Other ------------------------------------------- _ Number of living units:__ ___ _._-___ Number of bedrooms -- Garbage Grinder ~ ._ Lot Size 10_"e/W-------------------- Water Supply: Public System and name ------------------------------------..-------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ —.Peat❑ Sandy Loam ❑ Clay Loam .E] Hardpan ❑ Adobe 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.] I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANKJ4 Size_- � �`.____-- Liquid Depth -.'� .-�__________.____. Q ' Capacity 949_l�_ Type .- —Material- aC o. Compartments --________________ ` Distance to nearest. Well ------------- ______-__-______Foundation _Af?�___________ Prop. Line ____________ LEACHING LINE No. of Lines -----f----------------- Length of each line.........&&-------------- Total Length ,__.010-_r_______________ 'D' BoxkV--_____- Type Filter Material ,0_eh-_____Depth Filter Material -__ --" Distance to nearest: Well — Foundation __,111 --------- Property Line ,.5 .................. SEEPAGE PIT Depth-____ Diameter ---------- Number /---------------------- Rock Filled Yes, No (3 Water Table DepthOL) = Roek Size /Z Distance to nearest: Well -..� ______________________Foundation --/Q-P_________ Prop. Line -X---------------- REPAIR/ADDITION(Prev, Sanitation Permit# ____________________________________________ Date __________________________________] SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ----------------------------- -----------------•-----•-••- Disposal Field (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 o he work for which this permit is issued, I shalt not employ any person in such manner k as to become subject Work an' Compensation laws of California." Signed - ( , ------------------------ - ---,7 ---------------------------------------------------. Owner �- BY -------------- -- r } -------------- -Title --------- -------------------------------------------------------------- 1f other n owner] f FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY -- C-_- -U- --------- ---- -------------------- ---------------------------------- DATE _313/"---•----------------- BUILDING PERMIT ISSUED -----------I ------------------------------ --------------------------------------------------------- ------=--------------DATE -----------------------------------------•- ADDITIONALCOMMENTS -- ---------I --------------------------------------------•-----••--------------------------------------------------------------- -------------- --------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ---------------------- - - ---------------------------------------------------- ------------------------------ � ---- ------------ ---------------------------------------- ----------------------------Date -------------------Finai Inspection bSAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M