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FOR OFFICE USE: PPLICATION FOR SANITATION PEP T (Complete in Triplicate) Permit No. ---73'3J --- ------------------------------------------------------ Date Issued _�___�°l3- 9-3 7 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: JOB ADDRESS/LOCATION .__. _7 f - \--------------- ______�1tvI_-�1..-------R- --=--- ------------CENSUS TRACT __.:: Owner's Name -------------------- --Q-H_N.... --- J1_AfA--------b C�-tj-------/�n--- ---------- ---Phone ------------- ------------------ Address -- -- -- -------IM � C �V R�-------------- City ----MIM-14--- ------------------ ................................. Contractor's Name ....... -W ---------------------------------------- ------------------.License # . ---------------------- Phone --- -------------------------- Installation will serve: Residence (-partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ----_------------------------------ ------- Number of living units:-----/---- Number of bedrooms ______Garbage Grinde�F-5. Lot Size ____��-©__ �R _.._.._. Water Supply: Public System and name ----- ----------- --------------------------------------------------------------Private Fi � Character of soil to a depth of 3 feet: Sande 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 seeps -pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size___�_PtX/0(. A- 67--- Liquid Depth ___. _____ 0 Capacity ___ Typ C �_-STMatenal_ O/IC -_ No. Compartments _-,Z— --,z .................... istance to nearest: Well ------_� �fi- �_-fi- � f------- _________ ____________Foundation ___� .._ Prop. Line ___.,57__( ___ ____ LEACHING LINE [ No. of Lines _-�:.J--_-_____--_- Length th of each line-_--_-7 .__-______ Total Length _____r1-� _._e._.___. 'D' Boxy _ « _ _ Type Filter Material Depth Filter Material -------�_-_ _ Distance to nearest: Well . .t Foundation __-___�Q__ �_ Property Line --------------'L_ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ________._-_ ------------ Rock Filled Yes ❑ No C] Water Table Depth ------------------------------------------------Rock Size ---- --------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------- -------- Date ----------------------------------) SepticTank (Specify Requirements) --------------------------------------------------------- ------------------------------------------------- --------------------------- DisposalField (Specify Requirements) --------------------------------------------------------- -------------------------- ------ -------- ---------------- --------------- ------ ---------------------------------------------------- ------------------------------------------ ------------------------------------------------------------------ ------------------------------ (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 signatur rtifies th lowing: "I certify tha i th erform e f the work for which this permit is issued, I shall not employ any person in such manner as to becom s j to Wor a s Compensation laws of California." Signed - ----- --------------- --------------------------- Owner By - -- - ----------------------------------------------------------------------------------------- Title -- ----- - ---- ---------------- ------------------------------- (If other than owner) �-- a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------J---t_A - ------------------------------------•-----------------------------------.._. DATE -----,�� Z BUILDINGPERMIT ISSUED ------------- •-------------------••--•----------------------------------------------------- -------DATE -------------------------•------•---------- ADDITIONALCOMMENTS - --------------•-----------••-•---•---•------- --------------------------- --•-----------•---•-•--•--- - ---------------------------------------- ------ -- ----------------------------- ----------- ----------------•-----------------------------------•-------------------------•--•------------ --------------- ---------- ---- ---- ------------ ------ ---- ------- _ Final Inspec - --------------------------------------Date - -.. Z -73----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M