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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _ 73- ---------- ----- - - ----- --- --- .... ......... 3.----------------.---_...._._.-.....__-._.... This Permit Expires 1 Year From Date Issued Date Issued ...7-LF)3 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 _/pO�a_✓o.._ i __-__ �' G. Temic _-CENSUS TRACT .---__._-_----.._... Owner's Name ._G��'jFF;cVt-----c-mil£G------------ ------ -- ----------- ----..-------- - ---..___.Phone ----- /`� -- ------ .� Address - _106.. _ S ._LS.E'L -.._......J''' - -- City .-ji Contractor's Name _...-: -� ctLEq!i. ,..License #®.Z -V/,73Phone _.54 ,,, Installation will serve: Rdfdence��'Rl Apartment House❑ Commercial ❑Trailer Court ;❑ Motel []Other Number of living units:___...._ Number of bedrooms __ .....Garbage Grinder -__-___--___ Lot Size Water Supply: Public System and name --------------------------------------------------------------- --------------------------------------------Privat Character of soil to a depth of 3 feet: Sand Silt❑ ClaKlaterial Peat El Sandy Loom ❑ Clay Loam E]Hardpan ❑ Adobe ❑ ___ . 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 [ ] Size - Liquid Depth .__.....-...._.._._- 6 Capacity _______---... Type ----- ------ Material.____.-..._- - No. Com artments O P ._......... ... / Distance To nearest: Well ..._------._-------..__._.__.Foundation -._._....._-.__... Prop. Line _-------------------- 6 LEACHING LINE , [ ] No. of Lines ___ 1 . g eg g ----- --- Len th of egch Une --- -- _.. Total Length __ v -------- � e�rr rr 'D' Box _ Type Filter Material _/�.-' ..Depth Filter Material -_1116F----------------_..�----- Distance to nearest: Well ...,/1112.- ..... Foundation /./CF....._._. Property Line ._1,97--------- ----- SEEPAGE PIT [ ] Depth _ _ Diameter ._:?' ----- Number ___{-___. ------_r Rock Filled Yes 9 Water Table Depth ___-__�_�._-------..._.__._....._Rock Size o ___/1------ (� Distance to nearest: Well - ------- -----------------------------Foundation ------------ Prop. Line ..._------------.._. REPAIR/ADDITION(Prev. Sanitation Permit# ....-._....__................_____- Date I Septic Tank (Specify Requirements) . -------------------------------------------------- - ------------------ -/.,�/r.�.----------- --------- Dispo I Field (Specify Requirements) ... - -._ -�..)....,� ---- ---- .. ci..(6 �--------------- -- - - - - - - - - ------....- - (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 becomcT to Wo marts omp tion laws of California." Signed . - - Owner By - h . .. ....-.._-.-.... Title (If other than owner) FOg DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.... ........................ ------------ -------- DATE -L�. .._Z-^1 BUILDING PERMIT ISSUED .-------------- ------------ ---._.DATE _..... _-----------------_-----. ----------------------------------------------------- ADDITIONAL COMMENTS ....... ------- - ...... ----------- ------ - _......... .. - - -- --- --- - -------- -- - - Final Inspection by: -- -- -- ----------------------- - ---- -----------Dc SAN JOAQUIN LOCAL HEALTH DISTRICT -- GU E. H. 9 1-'68 Rev. 5M