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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ......... 73—�6 a <br /> (Complete In Triplicate) Permit No. .....................a <br /> ........................................... <br /> ......... ............•-•................................ This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION . ... L(© 47 , .0L 7— -I' 4 .}...---- . . .. ....... ............. ...CENSUS TRACT .Sq 7 <br /> Owner's Name ................liPk.0 .--- v=... --........ .................... .__.....- .. �5-/dZfa <br /> -c..--- - ....-- ...._Phone .. ..--- - -- -............. <br /> Address . ................[ Z.B.. ` .....� .,...�. !_6641ou7- P_V- City ._��_... aa <br /> .._ <br /> ............... ................ <br /> Contractor's Name .. .... (: ►i .r.'z"."�,�_---- ------.License # A4.13543... Phone <br /> Installation will serve: Residence [Apartment House,0 Commercial ❑Trailer Court ❑ <br /> Motel ❑Other -------- --------------------------------... <br /> Number of living units:.- _�...... Number of bedrooms ...`T-----Garbage Grinder -_.. ..... . Lot Size .._. <br /> Water Supply: Public System and name . ._................................... --,_....-.....---------------_-........... --------------_------Private <br /> Character of soil to a depth of 3 feet. Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 'Clay Loam ❑ <br /> -'Hardpan IX 'Adobe E] Fill Material ............ If yes, type ........... . .. . <br /> (Plot plan, showing size of lot, location of system in relation to wells, builcJings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit;permitted if public sewer is available within 200 feet] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK <br /> Liquid Depth __..dam . �.._.._._... <br /> r <br /> Capacity .I g ---.- Type __!^e... R- Material.. �*�*- No. Compartments .... ......... ------ � <br /> Distance to nearest. Well I01P P.'t--------------Foundation ....!!P 'i'...... Prop. Line��`^� �.._...... O <br /> LEACHING LINE No. of Lines Length of each line ..... Total Length , <br /> [ � .. g .....�..... . %gym................J <br /> 'D' Box Type Filter Material ./ ._-._Depth Filter Material .............................. <br /> 07 <br /> Distance to nearest: Well _ a.`.'`.•.. Foundation ®.�.'�..-.._ Property Line °�.._.. _r--__ <br /> SEEPAGE PIT [ Depth s r ...__ Diameter ...... Number .. .3. ... ....._.. ❑iE <br /> Rock Filled Yes Na <br /> Water Table Depth -. __-. .............................Rock Size ....... <br /> 1-?ra_ �q•� <br /> Distance to nearest: Well .......I `. ...................Foundation ....Ib.�'~._.__ Prop. Line 7s rr' (,T�' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ ... ............................._ Date -------------.------.-------------1 3 <br /> Septic Tank (Specify Requirements) ---- - ---- ------------------------•---------------•----------__--- ....... ...... ........... _............ <br /> Disposal Field (Specify Requirements) _...---------_---_----••-•--- ----------_ --------- - --•------- ......... .................__....... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the perfor nce of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become s ect o W man's Compens tion laws of California." <br /> . . �,.. .. . <br /> B .......... ... ............. .. .-_.... -• Title ....... <br /> (If other than owner - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . DATE �jJ ........... <br /> BUILDING PERMIT ISSUED ..... . . ..... .. <br /> -- - �._. .-------------• ---•- - ._DATE - ....- <br /> ADDITIONAL COMMENTS .. - . r.... <br /> ............... <br /> �.� � .. .!t .. .. <br /> ........ ....... -------- ............. <br /> ----------­------------ - <br /> Final Inspection by: .. ...... ',�. ':rt -------••-•----------- ............................. .........................Date ..` . 'a,. ............. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I3 24 <br /> E. H. 1 '68 Rev. 5M -- - -- - - - 7/723 , - - <br />