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FOR OFFICE USE: o APPLICATION FOR SANITATION PERMIT rf . .+.�l. c (Cam p iefa in Triplicate) Permit No. _73:..�0'� :....,........................................ ...... ........................................... This Permit Expires 1 Year From Date Issued Date,Issued k Application is hereby made to the Son 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. JOB ADDRESS/LOCATI ...............................................CENSUS TRACT..••- •---•---• Owner's Name .._........ . :...... . _ -,-•�'.. _ ._ Phone ...... Address ...... ................... ..��...U. �.......... --•-................. city .............. ...........-••-••-••-----••---•-- .. Contractor's Name .......-- ------------- .............License;#' - 5t.73Y . Phone '*&G f�..6 .... Installation will serve: Residence%Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other ............... ...................I....... 3 _ Number of Living units ... Number of bedrooms ...,..Garbage Grinder ..... lot Size .40' XZ1.a ............... Water Supply: Public System and name .................................................--------........... .•_.Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ _ Clay ❑ Per 0 Sondy Loam ❑ Clay Loom ❑ ,. Hardpan ❑ Adobe Fill Material ............ If yes,type ............................ (Plot plan, showing size of lot, location of. system Lin relation to wells,rbuilclings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC-TANK-1-1 Size:7.......... ................................ Liquid Depth Capacity ............ Types. .. ....:'.._..... Material{.-�------------ --- No. Compartments ...................... lv Distance to,nearest..,Well- :. ....:::.......................Foundation ...................... Prop. Line ...................... 00 t LEACHING LINE ( j No. of Lines ------------------------ Length of each line............................ Total Length ............................ • 'D' Box ............ Type Filter Material ....................Depth Filter. Material ............................................ rn + Distance to nearest: Well.:..::................... Foundation _:-----•--..._.__._.._.. Property Line ........................ G SEEPAGE PIT [ l Depth ____________________ Diameter ................ 'Number . ................ Rock,Filled Yes ❑ No [] Water Table Depth ...Rock Size'':...:..... r Distance to nearest: Well ......Foundation Prop. Line REPAIR/ADDITION IPrev. Sanitation Permit# Date .............:.. ) Septic Tank (Specify Requirements) s ... -- -•- ------ • ..... ......-•-..... _ Disposal Field (Specify Requirements) .....__._... ....... ...moi a.............................................................. ...---------------------------------------------------------------------------------.___...__;__.-_-_-......_.........._--..-.-_-....__..............-._.._._.-----1 (Draw existing and-required addition on reverse side) 1 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 fallowing: = i "I certify shat in the performance of the work for which this per`.rnit"lis.,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-.:`.... " ..............................: Ilf o er n owner) ((� O DEP T USE ONLY APPLICATION ACCEPTED BY ...... ..... ..... ...................................... DATE........ ' . .. . ... BUILDING PERMIT ISSUED ........ .. ...... --...... . . . . •....---••-•...... .........:..............DATE .... ... ........... ADDITIONAL COMMENTS ...... .. .. ..... ......... ....... . . .. ......... ......................................................... ...........I ...... -----•-- ... ...... .................................................... ........-_...-------------------------..._._... ......................•-•----------------•-... _ . ....... ...................................-................. ---------------•---------------•-------•---- •--•------••. -.......................................... ...... •. ........................-•--................................................:.................. . .. 11 Final Inspection by: ..................................,Date ..---• -•- - - • SA OAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M 7/72 3-M i