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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................. .----...................'.............. Permit No. ;74j77-..c�6..... r¢ (Complete in Triplicate) ...... . .. is . Date issued .................... ..........?!'��4il'd....... ............... This Permit Expires 1 Year From 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 i de in com lionce w'RE. nance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ! -' -!L/_ .. .._.................................. CENSUS TRA ......................j . .. ..-. I.. .....Phone.. �� Owner's Name Q Address ..................... ..... � ' �?.. ....City . .. .. ........ .... Contractor's Name ... 4. ��► _.Y" $7�8.. A/ec..license # ......................... Phone .�..-. Installation will serve: Residence Aportment House p Commercial QTroller Court 0 Motel ❑Other........................... ........ Number of living units:....'...... Number of bedrooms'C*3.....Garbage Grinder ....:....... Lot Size ./,d�1.�,. ......J .. Water Supply: Public System and name ................................._........................................................... ..........Private❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay 0 Peat p Sandy Loam ❑ Gay Loam k Hardpan Q Adobe kFiN Material ............If yes,type............................ AAdIRiAii®AO.AAAAI�I (Plot 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 I ] SEPTIC TANK{ ] Size................................................ Liquid Depth ....................,..... Capacity .................... Type .................... Material...................... No. Compartments .................... CA Distance to nearest: Well ....................................Foundation ...................... Prop, line .............. ...0 LEACHING LINE [ ] No. of Lines -...................... Length of each line............................ Total Length ............,...............0 'D' Sox ............ Type Filter Material ....................Depth Filter Material ............................-., Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT [ I Depth ................................. Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth ....... .......... ..Rock Size ................................ ¢' Distance to nearest: Well ........... ...........................Foundation .................... Prop. Line ............... ,� REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..........,__... .......... .) � Septic Tank (Specify Requirements) .......... '............................. ............................. .. ........-................. Disposal Field (Specify Requirements) ....... ....................................... ..................................a.' ..C2 4W4;W.....,/ JP_s.......................................................................,... (Draw ?. .tio.... �.r.. ...................................................................... existing and regfired dddin on reverse side) I hereby certify that I have prepared this application and that the work will be done M accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hem* owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, 1 shall not employ any penton in such manner as to become su ect to man's Compensatio of C ia." Signed ,tsar By ............................................................ ----------------- ... ........._........--... ...... litle ........................................... (if other than owner) 44dOR DEA NIENt USE ONLY APPLICATION ACCEPTED B .... DATE .,r .x.7..1. ........ BUILDING PERMIT �Gu' ��r/.•PISSU�ED,t�........ ..e.c.�c..s�...c..�r.:.E.....s.ci.ldf.�cPJ'��,,.er`4..-...�.a...�....DAT E ........................................... ADDITION41. COMME TS ._.... . .. of.. . ._. ............ .. . .all ................ : . .,....»._........ .......................................... ..... .. Final Inspection by: ...... ..Date 2.. i :. ................ r4 ..................... SAN JOAQUIN LOCAL HEALTH DISTRICT u_13 24 a--Aa m..,.,. c. - --