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S-73 FOR OFFICE USE! APPLICATION FOR SANITATION PERMIT s Permit No. _7 .. (Complete in Triplicate) r............. ........ ............................ i Date Issued ................... This Permit Expires 1 Year IFrom 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 mq4e in lionce it unty Ordinance No. 549 and existing Rules and Regulations. ,. ... Q C<. - ......CENSUS TRACT ........ JOB ADDRESS LOCATIO , ' _ �_. . . 1.� rtt "r~ :. ....Phone s~C7.9.`-?x.7 2....... Owner's Nome .............. " ;��.. - U` rc�vlx Cit '40 Address 37_.... ---- - -----•-• y .................... - r Contractor's Name .... Q -- -::..- : - .....License # J..�fPhone� •• Installation will serve: Residence Apartment House°;❑•C-ommeraai r Trailed Court ❑ . Otherrat-- - -- Number�of`living units:..... .... Number of bedrooms _. Garbage Grinder .._..._.... Lot Size ..__.... 'Supply: Private Water Public System and name .......... ......:....t.....:... •........ .�;:---....... _..... ..............� e s t Character oT soil to a depth of 3 fee" Sand❑ Silt❑ Clay'❑' Peat❑ Sor#dy Loam ❑ ' CIaViLoam ❑ I Hardpan E] Adobe Fill Material ........:... If yes, type --..-.------------- ---•-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc:mlust be placed on reverse side.) AI�P EW INSTAL AT{ON: (No septic tank or seepoge pit permitted if public sewer is available within 2Q0 feet,j r ,. Li � ACKAGE TREATMENT ( ] SEPTIC TAN [ Size..__.-- - ..X ....................... . quid Depth;....5 ..-._ QQ i ,y Capacity _... Type _.r {-- Material----w +^`5 -- No: Compartments ...................... .moo '� Distance to nearest: Well -------Foundation ..._-.T t........ Prop. Line ..................... 1 LEACHING LINE No. of Lines-. 'Length of each line .... Total length .f ..+. ........... 'D' Box .. Type Filter Material .................4--Depth Filter Material ----:..... ...}._ ,.,....... Distance to nearest, DOell _------------- Foundation Pt erry`Line .._.. ......... t` `Y I SEEPAGE PIT Depth . `j�.}r --------- Diameter _ ._.:__: Number Rock S :. Rock Filled"Yes No ❑ Water Table Depth k..... i---- Size .... .' ....._1_.i.��!•• r 3 r I Distance to nearest: Well --.-----_-� -------------------Foundation ......f0. '- .•1 .... Prop. Line ...J ---••-----••- REPAIR/ADDITION(Prey. Sanitation Permit# ----------------- Date ----------------.----------------- I Septic Tank (Specify Requirements) ...... •- ------------- F 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 Laws, and Rules and Regulations of the Sar+ Joaquin Local Health District. Home owner or liten- 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 . .. . ......... ... ............ ...-.,.. ---- Owner, 1] f t s:_.:.... Title ��' ...... ....................... By - ----- ----- ......a... ".• ... (1f other th wned ., OR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY-. -�..1.. .. ' --...-----•..... _.._-. DATE �'..f/ ..7•f ...................... BUILDING PERMIT ISSUED ---. ....... ._. .. = .,•_:..... DATE . --- ADDITIONAL COMMENT /: ............. "c ......................................................................-.. 7. f /� � r .... G. ....... Pel. .:Z� � .................... .. �.raf. ' •1aal. est ..;..�._ zr -- ._... ...-•-- Date . .: ____ Final Ins ection b � t SAN JOAQUIN LOCAL,.HEALTH DISTRICTw ., .i.. 7/723-M