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FOR OFFICE USE: .. APPLiCAT1ON Ii=OR SANITATION PERMIT P p-p ----------- E Permit No. .W:77-A-_l- (Complete in Triplicate) ---------=----------------------------------------------- I /d/ / g �(o ---------------------------------------------------- ___ This Permit Expires 1 Year From Date Issued Hate 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: JOB ADDRESS/LOCATION ----- �- ----------------------------- 't�y`--------:_(_-_ NSUS TRACT -------------------------- Owner's - -------------- - -- Owner's Name-w, -----------Phone.- �s-L ------ Address 3t76C, -.1.a, ..r Cite ------ - cY �'- - ----------------------- ---------- Contractor's Name ------- --- -----------------------------------------------------------License Phone Installation will serve: . Residence J�Apartment House[:] Commercial:❑Trailer Court Cl r Motel F-1Other ----------------------- -------------------- Number of living units:-----f Number of bedrooms 3_-----Garbage Grinder _-hv_--__ Lot Size ---�_6___-� �S Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private Character of.soil to a depth of 3 feet: Sand's Silt❑ % Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ t F � '. Hardpan ❑ Adobe ❑ M Fill aterial ------------ If yes, type ---------------------------- (Pl'ot 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,) PACKAGE TREATMENT [ SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth --------------_- Capacity -------------------- Type -------------------- Material------- --- -- ------- No. Compartments - -----------•---_---- „ Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING --------- --_--_LEACHING LINE [ ) No. of Lines ___---_ - _ .------------ Length of each line---------------------------- Total Length 'D' Box --1- ---_ Type Filter Material --------------------Depth Filter Material ------------------------------- Distance'to'nearest:.Well ------------------------ Foundation -----------------------. Property Line. ---------------------- S " -_. ._ • � SEEPAGE PIT [ ] Depth �` Diameter _-___-__ _�- Number ---------------------------- Rock Filled Yes E3Na i[1 - ----------- -- Water Table Depth ----- ---------s----------- --------- =-----Rock Size -------------------------------- i Distance to nearest: Well --------------------------- ---__-_Foundation _---.-----_-. ---- Prop. Line -_--..-_-________ # ( ----- REPAIR/ADDITION(Prev. Sanitation Permit#'---- ----- ----- --------I--------_-----_ Date ---------------------------------- Septic Tank -_--_-----_-_--_-_-_-_--_-_--_-_-5epticTank.(Specify Requirements) -----/ - t i D' osal Field (Specify Requirements] ---30 _ T __, -p - _-_ �----==----------------------------- -------------------------- ------ ----- -- ----------------- --------- ----- ---- --_ (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 Regulationsrof the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: �! . "I certify that in the perforrnonce of the work for which this permit is issued, I shall not employ any person in such manner as to become subjeto Work art's Compensation laws of!California." Signed ------- --------------- ----------------------------------- © � By ----' _ = -.t----= ----------------------- Title ------ - ---------------------------- (If ------------------- --(If other than owner[)99 i t h . FOR DEPAitTMENT USE ONLY DATE _��"/ APPLICATION ACCEPTED BY - - _ - ----_------ --- -- ---------------------- BUILQiNG PERMIT ISSUED __-_------•t- --------------------DATE ------------ - -- ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- i ------------------------------- -- ----------------------------------------------------------------------------------------------- -- - Final Inspection by: ------------------------------------------------------------------------------.Date --- `, l � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M