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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,... -. . . . _ _._..,. - Permit No. --------- (Complete in Triplicate) -- - - ---- - - ----- 3 4- 73 _-_ ----__-,___...._-__-_-_-_-- This Permit Expires 1 Year From Date Issued Date Issued -.. ti 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 ,inLcompli nce,e,�with County Ordinance No. 549 and existing Rules and Regulations: ` JOB ADDRESS/LOC N �C)33 -- - - XG CENSUS TRACT ---------.7....-------- Owner's Name --Y l ` - ------sT ti Phone -- --------- ------------------ --------------------- - - ----- ---------- - '- (`� -` -- - ----- - Address `,7 f� �^� �- -- - ---�J �-/-'- ------------- City _ ----- p - -G ------------------...... Contractor's Name ..---- . .. --z"["a'--- `-- ------�tl:----r-------------License # /"_3.4.. 'Phone Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court ,❑ Motel ❑ Other - - - ---------- ------------------- Number of living units:.......'... Number of bedrooms _ L._.-Garbage Grinder ------- Lot Size ----- r ---- j------- .. 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.) O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) IN PACKAGE TREATMENT [ ] SEPTIC TANK i ] Size------------------------ ---------------------- Liquid Depth --------------- -..-.._.- G1 Capacity ---- - ------- Type --- ---------------- Material---- -- -------- No. Compartments - ------------------ Distance to nearest: Well ..__ ---- ----------- --------- ...Foundation ----- --------- ------ Prop. Line ------------ ------.-. n^i LEACHING LINE [ J No. of Lines _ ---____--------- Length of each line__------__ ---------_. Total Length ------------.-_------------ 'D' Box _. -------- Type Filter Material Depth Filter Material ___ ---------_._-..-.---.-_----------- Distance to nearest: Well -------- ------------ Foundation ---_ -----------___- Property Line ------------------- SEEPAGE .-.._............SEEPAGE PIT [ ] Depth .... Diameter --------._ ----- Number Rock Filled Yes ❑ No ❑ Water Table Depth --------------------------------------------Rock Size ---------------- - Distance to nearest: Well -----....Foundation Prop. Line ---------------------- REPAIR/ADDITION(Prey. Sanitation Permit# . --.--------_ --- Date -----------------------.----------) �- Septic Tank (Specify Requirements) -----.__--/-� - - ')si osal Field (Specify Requirements) .LXt---� ----.- �+'-`--{ "-`-„"�-e----- - --- ---- ------- ------- --- ----- ------- - ........ - .. (Draw existing and requir addition on reverse side) 1 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 become subject to Workman's Compensation laws of California.” Signed ---------------------------- '- ------ ----- ye _ Owner By --.. ........ . . . . Title . - '� (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY/!i _ , , a ca -------------------- ------------ .__ ------------- DATE 1'.-___-._�� - - - - - ./... BUILDING PERMIT ISSUED ------- ------------------- - ----- ---------------------------------------------------------------------- - ---------------------------DATE ... - .. ----------------------P ADDITIONAL COMMENTS .-------- ----------- -------- --- ----------- ---------_ - ---- -- ----- - - - - --- ----------- -------- - ----------- - .. ....... - - -- .......- - -- ---------- --------- --------- _ . . . - - 1 Fina. . . I Inspection. - - - - by- :: -� - - - - Date .� - SAN JOAQUIN LOCAL HEALTH DISTRICT r 14 0 1-'AA Ro.. SAA