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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 73------ -------------- --------- (Complete in Triplicate) Permit No. - ----- This Permit Expires 1 Year From Date Issued ---------------------------------------------------------- Date Issued _ -------------------------------------------"---------- _ 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: JOB ADDRESS/1-0 AT.ION,QI._ �oZ----�J_ - - - - - ------------- G ------------------------CENSUS TRACT .-------------....._. Owner's Name_----- -- ------------- ---- ��?� -,f- ----�'-----------------------------------f��---Phone ------------- ----•-••-------------- Address ------=------------ ------- ----------- -----=---------- (/--------------•--. City ------ //�.r��' t _ Contractor's Name _-- - 1 License # 7 ---- Phone Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units_____________ Number of bedrooms _ -------Garbage Grinder ------------ Lot Size L06)0�ef Ylaz,...... Water Supply: Public System and name ____ ___ __ _/tEl �.- �..- -Private ❑ ------------------ Character of soil to a depth of 3 feet: Sand'❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ;❑ Hardpan ❑ Adobe [" kill Material ------------ If yes,type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted ifTublic sewer is available within 200 feet) (1 PACKAGE TREATMENT [ ] SEPTIC TANK'[ j Size___ _!_-_f�'_ --�i Liquid Depth __s�,��-_-___- r Capacity �(s�--- -- Type-_��___ Material_[e� �n�T__ No. Compartments ------- Distance to nearest: Well __._.--------------Foundation _____________________ Prop. Line ---/S LINE [ j No. of Lines _--_-�-------------- Length of each line---- Total Length :____ _ C�_`____:._ " I � . 'D' Box __ ------ Type Filter Material/ epth Filter Materia) ___� _ ______________________________ ; Distance to nearest: Well __ Foundation 14------------ Property Line ----�---------•-- SEEPAGE PIT 9 Depth s........ Diameter - - _______ Number _____�________________ Rock Filled Yes Zl,,/ No C] Water Table Depth -----------D---------------------------------Rock Size A Z , Distance to nearest: Well -----2A7; r-______________----Foundation -�Gt_f_-______ Prop. Line ______, .�_.___.__ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____-________________-___________) SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------- ---------------------------------------- Disposal --------- ------Disposal Field {Specify Requirements) ------------------------------------------------ -------------------------------------------------------------------- --------------- --------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- •--•------------------------------------------------------------ € 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 San 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------- Owner BYTitle ------------------------------ ----- ----------------------------------- (If other t n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- _ DATE --- 3 --�- BUILDING PERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE ADDITIONAL COyMENTS-------- --- ------------------ �� -- - --------- ---- ----------- -------------- -- ---- - --------- f Final Inspection by- -------------- -- -- ------- --- -- -- --------Z___ Date - F SAN JOAQUINOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M