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2 9 FOR OFFICE USE: r ; APPLICATION FOR SANITATIO�f PERlIIIIT r��7 ------ -------------------- --- ----- .---.----- :. Permit No 7.3 --------- (Complete in Triplicate) ----------I-------------------------------------------- pr From Date D'fe-psued .-�y:l�------- --------------- �3 ---------------- ------------------------------ This Permit Expires 'I Year D 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 County Ordinance No. 549 and existing Rules and Regulations: 33 i Uk ks --------------------- JOB ADDRESS/LOCATION .---- -- ----- -- ----- CENSUS TRACT ------------- Owner's Name -- .-r,- / -r,%z- it_4c YQ--=----------------------------------------------- -------------------Phone ---( ------ Address ----------------'I_i� B -------S ------ lG l Et_'. --------------------- . City �YLrG+ ..-----------------•----------------------.....:.- Contractor's Name = /-�c--1-� '/ --------------------------------------------License # �7J1. c Phone _ 3t`'= y`z� ------ Installation will serve: Residence t�Apartment House f-] Commercial :❑Trailer Court ',❑ Motel ❑Other .------------------------------------------- Number of living units:-___ ------ Number of bedrooms ---3------Garbage Grinder ---___--_ Lot Size _--- ------------------- Water Supply: Public System and name ---------------------------------•---------------------------------------------------------------------------•-Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ F Hardpan ❑ Adobe-4. Fill Material ------------ If yes,type --------------------------- = (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: o septic tank or seepg6Cp_it permitted i public sewer is available within 200 feet,} r PACKAGE TREATMENT { ] SEPTIC TANK'kQ Size_---5-•xs�t_y ?' ______._._. Liquid Depth __ _______________ �J > Capacity --/� �` ----- Type Material----+ {------ No. Compartments ------------------- ' -Foundation --- `------------ Pro Line -1-,)--�_____________ t ' Distance to nearest: Well .______.SO_`_________________ - P• l LEACHING LINE [ ]i No. of Lines ------------------------ Lengtho each line.---- --------------------- Total Length ------------------..---.---- II 'D' Box ._.-._------ Type Filter Material # ------------Depth Filter Material --_ - `": T 9: Distance to nearest: Well --------------------- -- Foundation ------------------------ Property Line; ----.._:--------..----- 4 SEEPAGE.PIT [ ] 1' Depth -=---=-c_N-r Diameter_ _: --- - _ :_, Numbetr --- ----------------------- Rock Filled Yes [INo i❑ - IWater Table Depth --------------------------,`-------------------`Rock Si- ----------------------------•- t r Distance to nearest: Well ------------ --------'-l- ?-----------L Foundation -------------------- Prop. Line .._.______-_-.__.___-- p F t REPAIR./ADDITION(Prev. Sanitation Permit# ---------- ------------ : - } Septic Tank (Specify Requirements) __________________ -------------- -----------------------------:.--�'--� ----------- ---------------------------•-1---------------------•-••- �r Disposal Field (Specif�L'Rei{virements}-----------�-.._ ------------------------- -----------1:}1.,------------- ---- --------------------------------•---•------- ---------- - --------- -I ----- ---- -- --------------------------- ------ -r ----------------- -- I R �� G. "---------------------- --------------------------------------------------- ------------------------------ ------------ ----- - , --:-• - •-(Drawexisttng and-required addition on.reverse side) r I hereby certify that"I haveiprepared this application Ind that the work,.will be done in accordance with San Joaquin i '' County Ordinances, State Laws, and Rules'and,Regulations of the San Joaquin Local Health District. Home owner or liven- ` # sed agents signature certifies the following: � "I certify that in the performance of the work For which this permit is issued, 1 shall,-not employ any person in such manner as to become subjects W lemon' Compensation,lawvv of California." Signed ` % ly/ --- -- � I Owner ------ " ________ _________________ 9 ----- -Title --------- ------------------------ ...------------------------- l (If other.than owner), FOR DEP. -RTMENT USE ONLY APPLICATION OACCEPTED t Y - { - - - 5 DATE ------------------------ ------ -------- BUILDING PERMIT ISSUED—_______ - --- ----------'--- - - - ------ DATE - ------------------------------------- ADDITIONAL ------------------ -------------ADDITIONAL COMMENTS ------------------------------------------------------------------------------ ----------------------------------------------------------------•--------------- ------------ ----- ----------- ----�-�-------------------------------------------4------ --------4.• -----------------------------------------------_---_----.--____--------.-..--_ _--------__-----------•--------------------- ---Z'---- ° 4_i'�------'!�\-....{k-=--------------------------------------- ' - --- Final Inspection by: ---------- - A -Date __.1 -- SAN JOAQUIN LOCAL HEALTH DIS 1CT '2-9- 71i-- Con '£z E. H. 9 1-'6B Rev. 5M ,�i