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FOR OFFICE USE: — r APPLICATION FOR SANITATION PERMIT IComplete In Triplicate) Permit No. .77--G .45 -- . Permit . . Date Issued /-.�5"•7� •� .............. ....................... This Expires 1 Year from Datelssimed Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dt scribed. This application is made in compliance with County Ordinance No. 549 and xisting Rules nd Regulations: i° p �- �c G JOB ADQRfSS/LOCATION ._. fR. - s... . .. �`�!. ... ... -?-fin ar `/)...........CENS S CT ......... ............ ... r Owner's Name Q.��J ,��#C,��4-- . .......... Phone Address `. . ...... .........•.... .. . , .. ........... . ........ ....City ........-...... . Contractor's Name � 4A........ .. s..a... ........:.............:License # � � fir` ... Phone --- ._... T�:.........�� Installation will serve: ', - Residence Apartment House C) Commercial ❑Traller Court 0 a� f MotelD Other ........................................... Number of living units:.....I..... Number of bedrooms .3......Garbage Grinder ...._... .. Lot Size ..... .. ............. ..:... Water Supply. Public System_and_nameF� .Private Character of soil to a depth of 3 fee : Sand 0. Silt❑ . Cloy .❑ Pea!❑ Sandy Loam 0 Clay Loam Hardpan Adobe _fill Material ............. If yes,type ............... ............ _ _ _ �-� - - - - ,.-•�-.tet (Plot plan, showing silo of=lot, Iocafion 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 ...•�Liquid. Depth - Size.....:..:.......•----...__...�.........----- Capacity -------,--.-----• --.. Type _---------- ------- Material.............:" No. rCompartments ......... ..oQs Distance. to nearest: Well ....................................Foundation ...................... Prop. Line .................. -'J LEACHING LINE [ j No, of Lines ........................ Length of each line. ........................... .Total length 'D' Box ............ Type Filter,:Material_:.:.:.:_. _._..-_.Depth .Filter Material .........."t...............................rn Distance to nearest: Well .......... Foundation --------:.............. .tProperty line SEEPAGE PIT j Depth .... • - ......._ - .._.. Diameter ---------------- Number ............................ Rock Filled Yes [3No 0� Water Table Depth -•---------- -----=------------- ------------Rock Size ...................1........... Distance to:nearest: Well .....Foundation . Prop. Lino ..................... . W 0.. REPAIRADDITION[Prev. Sanitation Permits .................._ . ........__ Date .....--•--••..........:........•-• Septic Tank (Specify Requirements) IfX -1---• ......................... � � ] ;4...................... .-.......•.--- -- D posa! Field [Specify Requirements) .---_-.--- r---.-••..••- ............ ..._____._---_---_.. ! 111C(( -, 4 y�"�.. ..........................'•-'--�---. 9K -- _ ..__.. .. .. ...... .. ..... ... _............... . a ----------- ............. . (Draw existing and required addition on reverse_side] _ _ I hereby certify that I have prepared this ppplicotion and that the work will be done in accordance�witk,San TJoaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heallh:01strict. Home owner or Ilcen- sed agents signature certifies the following; "1 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 betaa subjectto or-�kman''sCompAtionaws California." Signed_._. _,.ate-FT K ---- : 0 wneY. BY - :...... ..... ..... ...... Jitle...CQ_.�Lam. ._....__...... (If other than owner) f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........ ....... . . .. .................. ._-• -----_----- DATE 71-5 .. .7.._. .. BUILDING PERMIT ISSUED -------- �:'.._.. ..._._ :: r ..-DATE ADDITIONAL COMMENTS ........................ . • - ._._- -------------- - - .. _ •..................................... ---- - -- ---------- ----. ---• -• ------------•---..... .............,......... ....-------- Final Inspection by: ------- - •- - . -- ------------------------•---•_....------------------------••--•----...---•--•--..._Date ..�.'.., ; EH 13 2L 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT $/7h .•3M. _ ......