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FOR OFFICE USE: y APPLICATION FOR SANITATION PERMIT ......................................................... � �✓ �� (Complete in Tripllcatel Permit No. .................I-------- This Permit Expires I Year From Date Issued Dote Issued ...3;Z! 73 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/LOCATI N .......02 . ............ ................_.........---.....................CENSUS TRACT Owner's Name .-......- �o �-761jr� ,. Phone Address .................... r,.. -. .. City ........................................... ... Q Contractor's Name .... ...................License # .a..5Y73Y.3 Phone .Vi6 l�tnl�7.. Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court j_] Motel ❑Other ............................................ Number of living units:..... Number of bedrooms ��.....Garbage Grinder . -. ..-.. lot S ❑ ize J�X ,ra.��..................... Water Su I Public System and name r pA Y� ----------------------•-------.._...._._........_._......�----.. ...-------. ..- --- --.._............---•--Private Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ Peat❑ Sandy Loam l] Clay Loam Hardpan ❑ Adobe [] Fill Material ............ If yes, type....:.......... (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, -etc. must be placed on reverse side.) NEW INSTALLATION: (Nonseptic tank or seepage pit permitted if public sewfr is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKW Sise-...... .-/ .&-.------•-------•-......- Ligt,id Depth ...............� Capacity .��?U.__'`�. Type ...(� Material_. - No. Compartments ........ .....Z........_0 Distance to nearest: Well ....................................Foundation ....l�...*_...._ Prop. Line ........... ......... .. �1 LEACHING.; LINE No. of Lines .........,J........... Length of each line........ Total Length ..�7.a..�......___. 'D' Box .....`r-- Type Filter Material . ....Depth Filter Material ..f-�..... - J -Well Distance to nearest: Well ...........:............ Foundation .:.l -.f ....... Property Line ... ...._. ......... Q. SEEPAGE PIT ( ] Depth Diameter Number Rock Filled Yes ❑ No Q Water Table Depth ...Rock Size Distance to nearest: Well ..:.....................................Foundation .................... Prop. Line ........ ............ REPAIR/ADDITION(Prev. Sanitation Permit# ........ Date ..................................) Septic 'rank (Specify Requirements) .........................-....................... ....................................•_.............. ..--......... ._.. Disposal Field (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 Lows,,Nand Rules and Regulations of the San Joaquin Local Health District. Horne 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 Work"n's Compergation laws of California." Signed ........ ........................... .... Owner 13y .. ................ ....... .. f . Title ... i.... .. (If other h n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------I....... - ---•-•..........................•---------------••------- ..........--------- DATE .....! ............. BUILDING PERMIT ISSUED ...__,....... . • ..... --- ...., ADDITIONAL COMMENTS ..�` .:'-.73____-- ............................................. .. � ::: :: /V .......----- --- ........ .. --------- --....... Final Inspection bY. -••.......--- e �-------------•••. ......--...-----...---.....----•--• ...Date .. �/ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.1-3 24 1-'68 Rev. 5M __ 7/72 3 M