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r FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT .......-- :.............................. Permit No. ..7..-..: . (Complete in Triplicate) ............. ....................... .:�.• :�. __ ........... This Permit Expires 1 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 Ordinan No. 549 and existing Rules and Regulations: <• JOB ADDRESS/LOCATI N ...��f1%�_f__ --JI CI: •` ...,...-CENSUS TRACT .......................... 7� 6(/f [ c� .... Phone . Owner's Name .- ... ... ..-- ...2. :•-c�� ..._.... � ' CSS°` 'C _ �R 3y1a' .... I Address .- � .: .[ :� TZ- .0 ...... City ...--•--...I........ l .... ' Contractor's Name-.':�----------- .License # _---- Phone Installation will serve: Residence ❑ Apartment HouseCommercial ❑Trailer Court �y, Motel ❑Other ../'!:�?��..Y��t-'.=nom.-..:.._ n� Number of diving units.--.-.-/..-- Number of bedrooms ..3.....Garbage Grinder Lot Size .-&I& 4---c_.:�___........... r Water Supply: Public System and name ...............-................................................................................................Private Character of.soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat❑ Sandy loam Clay Loam ❑ , Hardpan ❑-' Adobe-[3 -Fill Material ".,-�:_:-if yes,type=-::--_---`-----•-••-- 4 {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 see age pit Permitted If public sever is a�ilable within 200 feet,) PACKAGE TREATMENT � � SEPTIC TANK Siae_�6..� �.--k---r••f••- • - Liquid Depth ...4i1......`....... 1 Capacity /4�.-_o 0 g?0'Type Material �'�D�er� No. Compartments .--2 ......: .- Distance to nearest: Well ...............Foundation Q.. -•.-- Prop. Line .5..7r.. !_..._ B� Total Length .. .Tl.. LEACHING LINE No. of Lines ........ ............ Length o each Ione._______........_ _.------ g r V 'D' Box .I. - -- Type Filter Material .. VCk..........Depth Filter Material ............:... Distance to nearest: Well ...*"0� _f r .. Foundation .......... Property Line,> .......-- SEEPAGE PIT -,:rDepfh a -, �_.'...._ Diameter .ce. _~-_ Number ...._-��--.............. Rock Filled Yes- No ❑A .Rock Size -- ....:. --....... Water Table Depth __ � � � ------ � r J Distance to nearest: Weis;_.,/__ . ..........................Foundation _. _.. 00 Prop. Line ....----•.-._. � . _ _ y �# �~� REPAIR/ADDITION(Prey. Sanitation Permit ............--••............................ Date __.......... .....-•---..... .} SepticTank (Specify Requirements) ......-•........:.. ....................•--...----...----•---.-----------•---.:.................------ -----...............-----------.------ Disposal Field (Specify Requirements) ' .. --------------------------------------------------•-••--••---- .................................... --......-------------------•---..............---•--------. ................... ..... .,� . �... .. �-•� . . ..... 1 .. ...... -. �._:- .:: � .................... ..-...._.`°-.-----.- --__.._.-.�--..............._._ .._ ...•`�' - (Draw existing and required addition on reverse side i I hereby certify that I have prepared this applieatiori',and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loral Health District.Horne 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 mann as to become sub'ect to Workman's Compensation laws of California." Signed ._. 77 6AC ..Owner ............l ez..&......i ` By . �t ................. title (if other than o er) r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._ .. . ..........•---Z........ . ............................................ DATE ........ ...�..73---------------- BUILDING PERMIT ISSUED ................... .•--- DATE .....---...........--....... ADDITIONALCOMMENTS ........:.................................................................................... ..................................... .......................... .................................... . . ------------------------------- . ._..._. .r.- f . �l�/ ...�. Final Inspection by: ....'__._ ....Date . .. SAN JOAQUIN LOCAL HEALTH DISTRICT tA E_ j4-1324 1.'69 Rev- SM 7/72114