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-FOR OFFICE USE: APPLICATION FOR SANITATION P,21T ................................ Permit No. .73- 7T1 (Complete in Triplicate) .................................. p ----- This Permit Expires 1 Year From Data Issued Date Issued T:�,2 f. J 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 .- .._ "T........._ ...... --- -------— ......... .................CENSUS TRACT ........... -----.------- Owner's Name ..........- �r Y't� ''`----------------------------------- -------- ------Phone ..8J557�i!�?.Q __..... Address :....... .. ..:............. C - ��.. ---•- ---. City C�tsta _... ....................... .............. -:{{7( Rftts �rs r;;kt_..,.-License #as 3 3 Phone --. Contractor's Name ....... ........,...... . ---- -__-- Installation will serve: Residence [INI#partment House-E] Commercial ❑Trailer Court ❑ Motel C].Other.....- ....... ------ Number of living units:........1... Number of bedrooms .-3......Garbage' Grinder. . .-_ - .. Lot Size .... ..............._-- ! Water ,Supply: Public System and name ---- -- -------------------------------------------------...---------•----_.....-------•----•-------- ........Private ! Character of soil to a depth of 3 feet: Sand C Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam i Hardpan ❑ Adobe ❑ .Fill Material ...... .... If yes, type .......... ._... (Mot 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,) / i PACKAGE TREATMENT { } SEPTIC TANK Si Depth------:.. Liquid Depth _.�� . ......... !! Capacity Type if =.0 Sf'_ MaterialNo. Compartments ._.` .............. !� Distance to nearest: Well __ a_`_.--_'.,_.............Foundation .... r.!`..... Prop. Line 0 LEACHING LINE [ } No. of Lines Length of each line. .. _IF0. Total Length ....J 4_�............. S D' Box ..� Type Filter Material _._._..Depth Filter Mate►ial _.._ _................ ................ 0 Distance to nearest: Well .....,J?'_.'F._ Foundation Property Line ..��_�.'i------------ SEEPAGE - ------SEEPAGE PIT [ ) Depth Diameter Number, - Rock Filled Yes ❑ No (]� Water Table Depth -----------------------------------------Rock Size .. ----------------_---- P Distance to nearest: Well ----------------------------------------Foundation Prop. Line -.-• ..........._--� REPAIR/ADDITION(Prev. Sanitation Permit# ------------- ------ -.•I ..................... Date _.._ ---•-•------------------ l° 1 Septic Tank (Specify Requirements), ----- ---- ---- ----------- --------- ------------- .......... --- --- Disposal Field (Specify Requirements) ... ... .............. ...... ........------ --------------------------- - --- - ................-----------..----- ------ ----- --------- (Dra'w 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 Heaith District. Nome 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 lowx.of California.." Signed . .. .. . ... ....... ..... Owner By .......... .... --- .._ Title tf'., . .. ....._.... . .. .. . ... j (If other than owner FOR DEPARTMENT U E O APPLICATION ACCEPTED BY , ... ... DATE � BUILDING PERMIT ISSUED .. ._.. .. _ ... ....... _-- . . -. ..DATE .. . ...... .... .............. .... ADDITIONAL COMMENTS ------- - --- --- ----...... �........................... .. ........................... .............. .. . .......... ,- Final Inspection b Date ... . ... . off.._.. P Y: ... en�.� fnAn111A{ 1("1["'ei uFe�Tu r� ICT