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FOR OFFICE USE: F APPLICATION FOR SANITATION PERMIT 77- �y C , ' 3 s.................. �.m._._. Permit No 7... ....._ (Complete in Triplicate) --........v.................................. _ 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 t described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulotionss ~- y JOB ADDRESS/LOCATION ......-�3.�-.+�.-,......_�.....-----�L..y_r..w................... .._.....CENSUS TRACT ..._...__.... ........ _ S .....Phone ......... ._. Owner's Name ........�.�eG.1..L..---- ,f�,E1.T..`.��/,�•---..---------...... _......................... �..............--•- Address ..... -+� City ........._. . ' ` lCT?"1!✓........................... ........-- __ . . . . _.. .............• •-----........-•-•••--.... Contractor's Name �"c��' � 1 ` Z'......./ !; _License # Installation will serve: Reslclenced Apartment House f3 Commercial❑'frailer Court Q Motel ❑Other -----------------•----- .................. o . Number of living units _.. ----- Number of bedrooms Garbage Grinder ....•.•..... tot Size ......---7 X l' ......•• Wafer Supply: Public System and name --------------------- L:.. ✓. 7 .___................................,.......Private ❑ { Character of soil to a depth of 3 feet: Sand 0 Silt Clay 0 Peat.0 L Sandy Loam ❑ Clay Loam ❑ �Hardpan_ __Adobe,&_Fill Material".............If-yes,_type .......I....... ............ lPlot plan, showing size of lot, location of system In relation to wells, buildings, etc. must I?e Placed on reverse side.) NEW INSTALLATION: (No septic tonic or seepage.pit per if public sewer is available within 208 feet) ' PACKAGE TREATMENT [ ] SEPTIC TANK ] � size-Y..-----------........... ...... tiqui.d'Depth .......................... W Capacity yp .................... Material...................... No. Compartments ...................... r Distance to nearest: Well :......................•--------•-••Foundation �................... Prop. Line ...................... 6 LEACHING LINE No. of Lines; -;--------... Length fcf..each line------.-.yQ.-'........ Total Length .... gip.-- T e Filter,Material S �t°�Depth .Filter Material •._......19`.`.....•••- 'D' Box _.. yp - --�---.. ............... . Distance to nearest: Well .... Foundation ....... ........ Property Line .....ST!............... .----- O ometr 3 3 Numio ber .......).................. Rock Filled Yes No Q r- SEEPAGE PIT, �. Depth --. ••-- 1 . Water Table Depth Rock,Size o�✓ Vis' ..... Prop. Line ......... :........... Distance to nearest: Well ------ .....--•--_..•..-......_ Foundation I REPA y . w lR/ADDITION(Prev. Sanitation Permit ----••--••---••--•------t••-••............. Date ......•----_--------...-------•---� - r Septic Tank (Specify Requirements) ......................................•.......... Disposal Field (Specify Requirements) ----------------------•-•-------- .................... .............. ....................................... ----------------------------------- .-_-------------- ----------------------- ----------------......_...................................... .... t -- ------ -------------------------------- --- l (Draw existing and required addition on reverse side) E I hereby certify that I have prepared this application and Abot,the work will be done In .accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin tocol Health-District. Home owner et licen- I sed agents signature certifies the following: "I certify that in the performance of the work-for-which-this_p ermit_ls_issuecl,-I.shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." ' � Signed ....... --�'-- ........�e-r•--•. Owner i�Cr�T.I_'_.�-J-�"�_.....��•� ._...... .. J..................................... By ........ ------- — Title - -------------- (if other.than-owner) 3FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ DATE --,i---, ..-•................... BUILDING PERMIT ISSUED _.._. . --- -----•--_-•-- .------ ------ DATE ADDITIONAL COMMS f } -----------------•-------------------------------------------------------------------------------- ..� '77 r _ --------------------•-•--••--------------------•.-.--.-.....-- --------- ......-- • . .... . . -------•--..... . -- ..............Date .... —, . Final inspection by: ------ EH 13 24 1-68 t SAN JOAQUIN LOCAs. HEALTH DISTRICT 8; 4 3M C. 3 i t