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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 73� Permit No. �(J-7_------ - (Gomplete in Triplicate] __._ ____ _.-_ ___ __._ This Permit Expires 1 Year From Date Issued Date Issued ��-A -- --- ----- -------- - P 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 ADDRESS/LOCATION /_A-40 7 Ad/--- ,�.--CENSUS TRACT -------------------------- Owner's Name .;07 ---------------------Phone ------------------------------------ Address -- fes-7i��( .8. fJCity / !`aT - - ---------------- Contractor's Name -__/'PQ License # - `---,-_------------ Phone ------------------............ ra.. __ �- Installation will serve: Residence []Apartment House-E] Commercial []Trailer Court Motel"❑Other -------------------------------------------- f Number of living units:__(D_--- Number of bedr�o+oms-�----_Garbage Grinder ,4/Q-,,Lot Size .2.,-- _ ---------------- Water Supply: Public System and name ---------------------- -------------- --° -------------------------•------------------------------------------------Private, Character of soil to a depth of+3 feet: Sand Silt'❑ Clay ❑ Peat ❑ Sandy Loam -❑,. Clay Loam :❑ ,. Hardpan ❑ Adobe '❑ Fill Material ------------ If yes, type---------------------------- (Plot plan, showing size ofl lot, location of system in relation jto wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: �(No septic tank or seepage pit permitted ifpublicsewer is available within 200 feet,) PACKAGE TREATMENT [ ]j SEPTIC TANK[ ] Size.------ Liquid Depth --------___--_-------_-_. Capacity -------------------- Type ----------- ------- Material---;------------------ No. Compartments ----------------------- Distance ---- --------------•Distance to nearest: Well ----------- --------/-------- ----Foundation ---------------------- Prop. Line -----'-_-------_- LEACHING LINE [ ] No, of Lines ------------------- Length of each/line------------------ - ------ Total Length ------._-_-.-----_--_--_-_-. 'D' Box Type Filter Material -------------------Depth Filter Material -------------------- ------------------------ Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line --------- -------------- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------ -----.--------- Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size -- ------------------- Distance to nearest: Well -----------------------------------_---.Foundation -------------------- Prop. Line ---- (Prev. Sanitation Permit# -------- ----.__-------------------------- Date ---------------------------------- Septic --------------------------------_Se tic Tank (Specify Requirements) -----------_- ------ ------------ -- n � / j Disposal Field (Specify Requirements) ---.-- _l7 -_---� 1i _1__-- j ------- --- -------- . ---------- ------------------------------------------------------------------------------------------------- ----------------------------------------------- ------------- (Draw existing and required addition on reverse side) I hereby certify that I,lave 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 performanie of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workm"an's Compensation laws of California." Signed -------- -- --- --- -------------------------------------------------- Owner By ---------------- --------- � = 0 `------------- Title --- - - -- - - ------dam- - (If other than owner( FOR DEPARTMENT USE NLY 4 -- DATE ----L�-77-z =4F.- ---------------- - APPLICATION ACCEPTED BY __ ____________�.___ _______�-i�-�:Y-^�--�--______________________._ BUILDING PERMIT ISSUED .- •-•----------------•------------------------------- =' DATE ADDITIONAL COMMENTS --------- -- ---------------- -------------------------------------------------------- �x-may�-�------- '---------------------•--------------------------------------------------------- --- ---- --- -------------------------------------------- --------------------------------- - ------------------------------ ------ ------------------------------------------------- ------------------------------------------------------------ ------------------- ------------- --- ----------- ---------- -------------------------- Final Inspection b ------ ------ 'S _- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M