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FOR OFFICE USE: • ' APPLICATION FOR/�ANITATiQN PERMIT 73_�'�d .................... .......................... ...... Permit No. ... (Comp a in Triplicate) - Date Issued Y�:.I:'.-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 Na. 549 and existing Rules and Regulations. - �JOB ADDRESS/LOCA N ..... ._ . t--�•-°.y� �• .CENSU5 TRACT .........-•--- Owner's Name ................. - ..............Phone �_ . Address ._a .'.. _._.._. .. /`-" '....... City ----� � ...-................................ Contractor's Name __________S.1/ _ _.License # _-_. Phone -----•- ... Installation will serve: Residence [) partment House'❑ Commercial OTraller Court [] Motel ❑Other --------------- ------_............... Number of living units:.___f..... Number of bedrooms .__.-_.Garbage Grinder ........__.. Lot Size ..... .....�,c A. ;,1.... Water Supply: Public System and name ...__................-•----......................................_......____..........................___...Private [V`r 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 pian, 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,] PACKAGE TREATMENT { } SEPTIC TANK Size.---. ..Z.a .4..Sa... ... ........... Liquid Depth ......_ ................... ---laa �- Com Capacity -----•------•- - YP$ -.......... tal...................... No. Compartments ..........---o4 O Distance to nearest: Well . Foundation .... .... .... .... Prop. Line - ,2441 - 0 LEACHING LINE (' No. of Lines ___________ ___A--- Length o Coch�line.-__.__,57,o . • - Total length ,Eo4.-... 'D' Box ...Om•--- Type Filter Material .., > Depth F- r Material ------ .................. Distance to nearest: Well ...... Foundation ________________________ Property Line SEEPAGE PIT Depth .,,2-,5..__.___._ Diameter ________________ Number --------- .......... Rock Filled Yes [;k ❑ Water Table Depth ................................................Rock Size .-----------•------------------- P. Distance to nearest: Well ----_------ Foundation ____________________ Prop. Line ....<F�0_Y REPAIR/ADDITION(Prev. Sanitation Permit# ............•-__------_---_- •--_-__-. Date --•--------------------•----------I Septic Tank (Specify Require A nts) .......•-•-------- __________________________________----_--------------------... -•--••-----_--_---------------•-----. - � O Disposal Field (Specify Requirements) ..... ........................ ...................................................................................... ---------- 3 •------------------------------------/ -------- ----------------•-•-----••-•--------- .............. .................................................._,_....... =-------------------------- --------------------•--•--- .-.....-•-.......................... --• ---adcl---•---•-• - •- •-----e' ----•... •--------------------- •----------------- ,........ . [Draw existing and required addition on reverse side I hereby certify that I have prepay 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 MoteZR7 ��.to sation laws of California." Signed :_�. � � -------- Owner BY - ..c ,p�a121b _....;,� .... . ., ..............................: ,r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------��"""•--------------------------...........................-........................... DATE ..___.'::...........................,.... BUILDING PERMIT ISSUED .............v__ --------- ....DATE ------..............._ ADDITIONALCOMMENTS .........................................................----_--------- -----------____ ..__----------_________________---------------------•---- .......... .................................... -----•••••-••--•-•••.,................................. ..............-...—.......................................................................... .., -------- - ---------------------------------------- f - ------•----.........__.......-----•---•------.. --- Final Inspection by: .......:.. ✓.:. .:7.�-�'�� ..',_.-••-••-----•. ................................................. ...Date `e--,e -V .................... SAN JOAQUIN LOCAL HEALTH DISTRICT (, E. H. 13 24 1.'68 Rev. 5M F 7/72 3 ,K