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FOR OFFICE USE: j r APPLICATION FOTO SANITATION PERMIT ........lit w. c... .... . .......... .. . r (Complete in Triplicate) Permit No. -73 Ah ................... v .... . ......W........... This Permit Expires I Year From Date Issued 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 No. 549 and existing Rules and Regulations. V JOB ADDRESS/LOCATION ...... l,�I. ...... ................. .. . .. ...................CENSUS TRACT ............. 3 - z� Owner's Nome .......................... ---/--------- --- - - - ...........-........_._..--� ----------- ................ ._..Phone . ..... ............... ........---- Address ............ ...... � 42...----.. ...._...- itY u ............................ Contractor's Name ___ ...............License # - S�f.. 5�3_ Phone Installation will serve: Residence[Apartment House Commercial ❑Trailer Court 0 Motel ❑Other -----------••-------------- .......-•...... Number of living units:..... Number of bedrooms ..._k�Garbage Grinder ............ Lot Size ..... ......... Water Supply: Public System and name ...................... ......-......................... -................. ........_...._....Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam D 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. (No septic tank or seepage pit permitted if public sewer is available within 204 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK-[ ] Size........ ...... Liquid Depth .......................... Capacity .................... Type ..__......_......— Material----------_____....... No. Compartments ................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line .._........... ....... 6 LEACHING LINE ( ] No. of Lines -----------------------. Length of each line----. ------ Total Length ....__........ ........ 'D' Box ............ Type Filter Material ....................Depth Filter Material .......-.................................... Distance to nearest: Well ........................ Foundation Property Line ........................ , SEEPAGE PIT [ ) Depth Diameter ................ Number ----------------- ...... Rock Filled Yes [] No C3oqn Water Table Depth -------------Rock Size Distance to nearest: Well -___--_•__----••___-_--•................Foundation .................... Prop. Line REPAIR/ADDITION IPrev. Sanitation Permit# ..:......................................... Date .............................. Septic Tank (Specify Requirements) ...................... 0........•--.. ..................•-•--....---------------------•--- J, t - . Disposal Field (Specify Requirements) ............... -•----- � `� •--•-•-- -•-•-•----..---•--------. ....................I...� ..'X. ..... �7 --- •------ �H -�. .........................................................I............. ..................... ------------............................................................................................ (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 ce `ifies the following: "I.•certify that in the pe ormance 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 By ............. ......... .......a-ltzl&------------........................... title ---- ------ --._ (if o er th owner) D NT USE ONLY APPLICATION ACCEPTED BY ......... DATE . ..—ev1—?73 .......... BUILDING PERMIT ISSUED pg DTE .... .......... ADDITIONAL COMMENTS l0. ,5 �„ �trcC ........................G .Y� --------------------------------------•-•..... ... _. ..... .....-----•-- ------ -----------••....._........._._......:........_..............._..... ............................... ._-..-._.. --....•------------------------------------------ --. .. ..............._..... .........................--•--......-----.................................... .... •------• Final Inspection by ..................Date ..... Q ..5�.7 . . SAN JOAQUIN�LOCAL HEALTH. DISTRICT E. H.13 241-'b8 Rev. 5M 7/723 ,14