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dm,4 4f FOR OFFICE USE: 51)� kio� APPLICATION FOR SANITATION PERMIT ,,// 3 ................... .......---......_...._.. r Permit No. .73' ��?d. (Complete in Triplicate) .---•.- --------------•.------__.-.-- ...... This Permit Expires >I Year From Dote Issued Date Issued IT 71 1, 7 3 — 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: 3013 ADDRESS/LOCTION ... c.;. .^, 1J_,_ 1� �S�S.....�t I.r!!�=1�-".CENSUS TRACT .......................... a Owner's Name -1.,dw 1-.1-�':....._._,V ,...................................... ........ ...... ........ . ----- •� - - -=------------------- Phone _ Address ----..._.... c� ._, c._ lt'!......---•-•............ City G � ..................................................... Contractor's Name . ..... ' `_ .............. .. ------------------license # ��-�:---- Phone Installation will serve: Residence partment House] Commercial ❑Trailer Court 0 Motel ❑Other --------------------- ----------------- -•-- y Number of living units ..... Number of b Ar r:.______Garbage Grinder _... Lot Size . r/.j. ...................... Water Supply: Public System and name ..... ... i.. --1 Tyr___. -....................... _-------------•-----..........Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam C3 -Hardpan ❑ Adobe Fill Materiol k `.___.. If yes,type a ............................ (Plot plan, showing size of lot, location ofsystem 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,) 1 PACKAGE TREATMENT [ ] SEPTIC TANK[]3' e... la ..� -��T. ... ....... ..... Liquid Depth ._....._... -� terial No. Compartments Capacity 1. 1-ko-----_- Type :�.... p J- 1 Distance to nearest- Well _.__��! .................Foundatio» �--._........_... Prop. line ....__.e.............� LEACHING LINE [ No. of Lines ......a.............. Length of each line__.. --- ,-,-,-- Total Length f.........,.._. r AV 'D' Box _. _.. Typd Filter Material ......Dep Filter_Material __/ .. 1............. Distance to nearest: Well ..A / .......... Foundation ID 1 Property Line SEEPAGE PIT [ Depth 5........... Diameter . .��.... Number ._...---!__.. Rock Filled Yes 0 - - • Water Table Depth .4^ - ................................Rock Size Distance to nearest Well Foundation . -.- 0 ....... Prop Line . ........... i REPAIR/ADDITION(Prev. Sanitation Permit# ---- 1 ---...................•.___._...-----------. Date ....----............._..__._ I / Septic Tank (Specify Requirements) ......................................................................................................................... - 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 Son 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California," Signed _.. - ................................... Owner By _ _.. title (if other an owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ..... .... ... .. ....... .. .. DATE .. ... ........... ............. BUILDING PERMIT ISSUED ................................ .................. ............... ---� ......<..............DATE ........................................... ADDITIONAL COMMENTS .......................�._............ . . ............................................ ..---------•---•--....•--..._...-•-------- .. --- ---- - - �... ----••----• Da Final Inspection by: 771, 1_ _...... ..._..... ..:��,��.._ ... to ....� SAN JOAQ LOCAL HEALTH DISTRICT E. H.I.3 24 1-'68 Rev. 5M 7/72 3 M