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FOR OFFICE USE: APPLICATIC>N FOR SANITATION PERMIT 3 --- -/C Permit No. . .............. .. (Complete in Triplicate) - .---------'� . 5---- Date Issued 3-3d'73 ---------------_-_------- 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. 549 and existing Rules and Regulations: L•--OJOB ADDRESS/LOCATION ... �- � �/V. -�.� h./_V........................CENSUS TRACT --- ------..-..----------- Owner's wner s Name -_ - - - _- :_- f. �A.......----------------- ..Phone 7¢s Address . ......••••• ...._. -- ---- 71- t7L'•-- -.L-tV. - •--. City rs TI�CfC.-.7�/-/ . "-----.. I _ ----- ----- .License # 1.49V -1.... Phone4-6faGh-f1-7 Contractor's Name ..._ -- - -.---�----�(�`�`-'�--'"-=------ '• �- - - f '"'-- Installation will serve: Residence�,Apartment House❑ ❑ Commercial Trailer Court ,❑ Motel ❑Other - -------•---•--- - --------------- - Number of living units:0 ._ Number of jZedroomsSON.-Garbage Grinder _. -- Lot Size ............ Water Water Supply: Public System and name _-.--:_ --.---- .--Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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,} I r i k PACKAGE TREATMENT [ 1 SEPTIC TANK fk Size... '}- ---��-x -�5 - Liquid Depth ,�__----------01 -----• _ Capacity/wo Type Materia _- - No. Compartments ..-.��..• Foundation .1-r0--- - ------- Prop. Line -...L�d -------- Distance to nearest: Well ------- Ann i�70 - Total Length .-----. Length of each line .............. LEACHING LINE 11 No. of Lines (2,. --- - - g n tt D' Box ._ ..__ Type Filter Material J.. ; .Q_X-Depth Filter Material -._�-- -- ------- -----------r---- •.__._ �� Foundation ZQ-__-- Property Line ---- - --••••C Distance to nearest: Well .............--._.._ �{, '-'r V Rock Filled Yes ) SEEPAGE PIT [ 1 Depth Diameter- -3.3 ---- Number jf Water Table Depth (Co �. . ---Rock Size -.--``�3------j--_ --- r � ..- Prop. Line ---------------------- REPAIR/ADDITION to nearest: Well _ ______ ________"-- ------------Foundation ------------ -- -------- - Date .._ ----j REPAIR/ADDITION(Prev. Sanitation Permit - . Septic Tank (Specify Requirements) ---------------- ecif Re .. - - -- Disposal Field (Sp Y Requirements) - :` ....................... -- - - ---- --(Draw existing and required addition on reverse side) prepared this application and that the work will be done in accordance with San Joaquin I hereby certify that I have p 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: person in such manner "I certify that in the erformance the work for which this permit is issued, 1 shall not employany as to become s�bje to Workma 's Co p nsa ' aws of California." -. wner Signed . --- ------- - - itle - By -- -- other than ow er) FOR DEPARIMENT USE ONLY ' DATE APPLICATION ACCEPTED BY .. Y -------.DAT -----•----•--• BUILDING PERMIT ISSUED ----- ---------- •-•--••- -- --------•------••- :... ------••- --•-•-•-•--- ADDITIONAL CO MENTS .. _ -• ---.•. .. U S - , - Date •- . Final Inspection by: •-- - " AN JOAQUIN LOCAL HEALTH DISTRICT