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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------•---- (Complete in Triplicate) Permit No. _73---------- ----------------- ---- ----------------- --------------------------------- ----- --------------------- ---- This Permit Expires IYear From Date Issued Date Issued .-.------------- ._.. Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance,with County Ordinance No. 549 and existing Rules- and Regulations: - _ � a Ga-►rr o. q /�/ /� JOB ADDRESS/LOCATION - -- - _a ./__----:(_ '° _ Q_ ��I_5-a_h--------------CENSUS TRACT 5 - --------------- ll`` q Owner's Name ---- � 11�ht 7, ----------------- Phone --`46_------74--/..1 1 City Address ---------� �--2---- -----------!:Y-�----- a t �� ---------------------- - l-C�p_Il�Dl3 - = 2_-/ ----- Contractor's --. Contractor's Name ---- --------��re_.-------- Y -/�./�----------------------License # 2-.®-;3$1-ZPhone _3__ ,9,266.0 f Installation will serve: Residence &<partment'House,❑ Commercial`:❑Trailer Court ;❑ Motel ❑Other ------------------------------------------- Number of living units:----I+------- Number of bedrooms ______Garbage Grinder _____________Lot Size _.�_Q�CeS__________-_____ Water Supply: Public System and name ----------------------•----------•----------------- ------------------- --•--=--------------------------------Private Character of soil to a depth of 3 feet: Sand'[] Silt C3 Clay Peat❑ Sandy Loam ❑ Clay Loam.D_ -W Hardpan E] Adobe'El 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,) ` e « PACKAGE TREATMENT { ] Sie_---__-_'_ - -__ quep ------------ � -------------- 3S Capacity l�� 0_.. Type _____ ✓} No. Compartments ► 0 1 --a------ Distance .to nearest: Well ___ __ ________ __Q___Faundafiion _____________________ Prop. Line .._._ ___ � LEACHING LINE ] No. of Lines -----�------------- Length of each line-----1-0 Q-_.-_-___ Total Length____ _ -�._.-• 'D' Box ----- Type Filter Materi?l eK----Depth Filter Material ------ ---------------_____------ Distance ____Distance to nearest: Well ----;FO----------- Foundation -_ I-Q_ ____________ Property Line ____--a--------- SEEPAGE PIT (] Depth ----__ Diameter - ------ Number _.__:2---------------- ___Rock Filled Yes *No ❑ Water Table Depth ------------1570--f.....E---------------Rock Size ------- ------------- x Distance to nearest: Well ---------J_-15-0----------:1-----Foundation _______ Prop. Line _:_ o._-........ V, 0 REPAIR/ADDITION(Prev, Sanitation Permit# ____________________________________________ Date --------------------.•---_-----_) � SepticTank (Specify Requirements) --------------------------------------------------------------------------------- --------------------------- ---------------------------- Disposal Field (Specify. Requirements) --------__------------------------------------------------------- --------------------------------------------------•--------------- 'r - r --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---•--•---------- ------------------------------------------------ --------------:- -----------------------------------------.------------------------------------------------------------------•------- (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 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 J; --------------------------------------------- Owner BY ------ Title � � � - -- ----------------------- -------------------------- other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- --------------------------------------------------- DATE ! ---- ---- BUILDING PERMIT ISSUED - -----•--------------------------------- DATE - ADDITIONAL COMMENTS ------ -- _.w-- •--------R° ---- ----------------------- -- ----- ` " � ------------------------------------- ---------------------------------------------------------------------------- ------------------- ---------------------------------- --------------------------------------------------- m Final Inspect------------------ -' ` `� ---- -- ------------------------------------------- y r• ' ------- - ------ - n by �` , ! '1` --------------------------Date � w - - ------ --- r SAN JOAQUIN LOCAL HEALTH DISTRICT F- 1! 0 1_'AQ De.. r.AA