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�-� FOR OFFICE USE: r, APPLICATION FOR SANITATION PERMIT tcomplete in Triplicate Permit No. .7� 7/ ....... ............AMA................. ..................................... This hermit Expires 1 Year From Dere 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 Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATIO .../YY9 .... - :-�� ..CENSUS TRACT .......................... ' Owner's Name .. GC '. .............................:...... ............ .......... /, ..City C� . Address ..------- .0_.... .. -----.. .. .................................. .... _; ........... Contractor's Name .. : ..4.-4 ..,44!0..License # :_7777 Phone W7J20. . . Installation will serve: Residence 0 Apartment House CQ Commercial OTraller Motel[]:Other- . . ... -_............... Number of Irving units:---✓__-_-- Number of rooms ._._..Garb age.Grinder '"i✓'�" Lot Size ._ 3c �................. ......... Water Supply: Public System and name ..... . .. ..... .. ... : ..._letW...---------------------------------------------------private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat Q Sandy Loam day Loam 0 Hardpan 0 Adobe Q Fill Materlal ............If yes,type... .......... ............ (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 ( ] SEPTIC TANK Size._ , ---- � ---__-_• Liquid Depth ...C... _ ,... Compartments .. ......... Distance to nearest: Well _fQ ..`.................•.Foundation .41*1a............ Prop. Lire ...is............ LEACHING LINE JV No. of Lines _00*............... Length of each line.- _!SS f ...�_.... Total Length .._ 77..............0 'D' -Box '"fes Type Filter Material . ....Depth Filter Material ..../.f .....�........,.. Distance to nearest: Well Aae.......... Foundation e.............. Property line :... .----.--------. SEEPAGE PIT SV Depth -c7 ---. Diameter .e `�. Number ...... .................. Rock Filled Yes* No Water Table Depth .......;91�--•--- --------------------------Rock Size .. i Distance to nearest: Well ...AAa.... ................:Foundation .1 .......... Prop. Line ..........--..-� REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. v+ Septic Tank (Specify Requirements( Disposal Field (Specify Requirements) ----- ..................... - ............................................. ------------------------------- ----------------------•-------••--••---.....-------------------•--------•-.._.-----•----•----•--•------•---.....----•-----------•---•........._..----------.............. (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 Regulations of the Son Joaquin Local Health District. Heine owner er Been- sed agents signature certifies the following: "i certify that in the performance of the work for whish this permit is Issued, I shall not employ any person,in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------ ---•--•-------------------- ------ - ----._........ - -- Owner BY ---- --••----_-- t.. .....OFV% •-----•..._.. title ........ ..........I.......... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . = -- -----•------------------------ DATE I' Z?_-76................. BUILDING PERMIT ISSUED _.......... - ---------- ---•----•------.- ------- . .__............... :. ....:_...DATE = ADDITIONAL COMMENTS ....--- ....................................:........_......._..... :...... ................ ..........................._.............._.........:...... .......................... _--.......-...._................ ....................... .......... ....... . .. ........ - Final Inspection by: ..._.. _:_.._. ----...-•..................Date `:L2 7�................. 13 2h 1-68 Rev. 5M 4dAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M