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FOR OFFICE USE: - APPLICATION•FOR-SANITATION -PERMIT _ Permit No. ..73_.'''0 8 (Complete in Triplicate) Date Issued ___. This Permit Expires 1 Year From Date Issued 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. 5/49 and existing Rules and Regulations: JOB ADDRESS/LOCATION . - U. .... ...... `' E^ ,! t"Y.�f/..��Z�c-tG------ ----------CENSUS TRACT -------- - ------- Owner's Name ......-•--------lir_c.S'a---------/.1k.1/d r.1-------------------- ---__---- --------- ---------.......Phone ........... Address •-----!'isr 14" y:+'4. •.... Ci Y •------ ........... `� city I a.c` Contractor's Name ....------ /.......! u_/1k`• ---------------------................License # Phone Installation will serve: Residence[Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ------------------------------------------- _ Number of livitg units:...../_._ Number of bedrooms .....1?___Garbage Grinder _/f/t?_.- Lot Size ................... Water Supply: Public System and name -----•-- ---------------------•-------------- •------------------ ------------......---_..._Private Character of soil to a depth of 3 feet: Sand❑' Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan [] Adobe ❑ Fill 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 if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK-T4 ,,'- Size____.......G37.v<-�2e- ----------------- Liquid Depth ....4P................... ,�1 Capacity _IP-1-12.____ Type /c�_�`�y e�- Material Yu`,_ No. Compartments r�'r. t r IfDistance to nearest: Well ----------s1.-l?__-------_-------__Foundation ...._..?U___.... Prop. Line__...fL2____-_.•.-.- LEACHING LINE [ ] No. of Lines ---------------t-------- 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 00 Water Table Depth ............. --------------------•-•...... ...Rock Size ...--------------............... Distance to nearest: Well -----_____---------------_..............Foundation -------------------- Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# -----------------.-------------------....... Date ..............._-__-__-_______._-) Septic Tank (Specify Requirements) --- ......... ----------- --•-------------................... -----•---------------____..........----_-_--------- Disposal Field (Specify Requirements) -------------------------------------------------...........-----------................................................ ----------._ - --•---------- ------- ----------------------•----------- ..................... - ---------------_................ ........... -----------...................... ----_... ...... 4- .�. (Draw existing and required addition on reverse side) I hereby certify that 1 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 pert rmance of the work for which this permit is issued, i shall not employ any person in such manner as to become subjectr��Patt rnpensation Laws of California. TT�� " Signed _----. ._ . ......... Owner BY - .-------- ...... - Title ---------------------_ (if other than owner) �-- -- ) FOR DEPARTMENT USE.ONLY I APPLICATION ACCEPTED BY ------------------ .••-•-----------` --------------•-••---••------._. .... DATE BUILDING PERMIT ISSUED ---- ------•-•--- -•------• ) ;.f.`:, DATE . ADDITIONAL COMMENTS --------------`.........`--------------• ....................................... ...... -•.. .............•---................. ........ •------ .---------------- --------------------------------------------- ------------• -.-..._...-•••-••--...••.... --------------------------•-------------------•- ---------------•--•--------••-- •--------•- Fina Inspection by: .,._.. ............ ------------------------ --------- Date ??_.... - SAN JOAQUIN-LOCAL. 6E H_DISTRICT,_,,,., E. H. 9 1-'bi3 Rev. 5M �..