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F1 OFFICE USE: � APPLICATION FOR SANITATION PERMIT 7.3- 'cold o _1 -- ., Permit No. ..... ... .. ..•-•.. ................... ..............C•--7prn- � SCompletein Triplicate) :......... ;; Date Issued .�`:�1�_-73 ...................... 111 This Permit Expires I Year From Date Issued he work Application is hereby made to the Son Joaquinn a wiHh Health CouDytOrdinarict rn a permit and existing Rulesand talndt Regulat oss herein described. This application is mode in comp! a ................. JOB ADDRESS/LOCA ON. Ph eZ� �L__�_ �. ENSU TRACT �.... _ ... � .Qs�tG.e.� one . .. ._ ..� .. .._ ...... Owner's Name �. ..__�.: . . �?! ...:............................. City -.. Address -- ._ ........ ..... .... .. �` ! . : License #;2slPhone � Contractor' m . .. . —�r Installation will serve: Residence ❑Apartment House Q Commercial❑Troller Court �. Motel ❑Other - -- 's"` Number of living units:-•----•.-_:. Number of.bedrooms ............Garbage Grinder ... Lot Size ------------.---------w •---•-•-•••••••-••• Privatex Water Supply: Public System and name.::: -_____-_-_•_-----•---.......... I Peat Sandy loam 0 Clay Loam C)k Character of soil.to a depth of 3 feet:.: Sand�] Silt❑ Clay ❑ -1Hardpan j] Adobe Fill Material _...._.._.._ If yes, type •-------_--------••- 1 t location of s stem in relation to wells, buildings, etc, must be placed on.reverse side.! (Plot plan, showing size of lot, Y k NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 2n4 feet,} -- e . � .- Liquid uid De th _: 5*...,..r..r....... PACKAGE TREATMENT,- [ .SEPTIC TANK. aM• •.. . � �• No. Compartments .... ....._. Capacity Type _ • atera ' 0 f t___••---- _Foundation ....,lO...._ -__- Prop. Line .... I Distance to nearest. Well ........ ..:.......... i No. of lines `:F-/=••'-'•.:_1.._-:. Length of each line----f -.•._•..__... - .--....---•••- LEACHING LINE �j. Total Length /OF 41 . -^ -_ D F tern - -- I Depth titer Material •D' Bax Type Filter Material A' 'D': f-----. .0oundation'____�©:� .._.__. Property Line Distance to.-nearest:�Wetl':..._ : __. .. �. A ----- -t — _ ,- ►- SEEPAGE PIT [ I Depth ___::--_-:-----• - Diameter =::......--... Number...-------- Rock Filled Yes ❑ No Water Table Depth .......................Rock Size :....----•-------------------- .............. Foundation Prop. Line ...................... Distance to nearest: Well :. . Date __...-------•.....................} ...---•••-- .......... REPAIR/ADDITION(Prev. Sanitation Permit .---,•---�••••-�----- - i i ----•- -, _ _ Septic Tank (Specify Requirements) ----------`.......... ................. Disposal Field pecify Requi►einents) rr ..............---------.......... -- _ ------------------------ . ...................... existing and required addition on reverse side) V\� I hereby certify that I have prepared this 60plication 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 follow'Ing'- n in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any parso as to became subject to Workman s Compensation taws of California." Signed - ............................t Owner ........................ Title --- -------------- - •- ......_.---- (If oth an owner) _ FOR DEPARTMENT USE ONLY I `'c!c'. DATE .... ............... .._. APPLICATION ACCEPTED BY -------- -:"""__-- -•.• �-�-• DATE BUILDING PERMIT ISSUED .. .............. ••--•- •• •• •• -- E ADDITIONAL COMMENTS .._ �.... ,.cam . ... ...= - '!' / .....---- ...... .. .tom ... -- _ .>....... .-• -- - - --------- •. ..Date ..... 5. 73 •-- ....... Inspection by: .._::--•-----e .......... -----. ........... .......................... . --SAN.JOAQUIN-LOCAL HEALTH DISTRICT" ,..� ...• ¢ - . 7/72.3 M