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FOR-OFFICE USE: r t ........... T APPLICATION ICOR SANITATION PERMIT � lCompleteIn Triplicate). _ Permit No.,77... .,. ..... ..---........- � ' 7 E Date Issued ....:n6'_- 7 ........................ ...-..-...---.._--•-- � This Perniit Expires ] Year From Date Issued r 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION .....��P � G'�ell ......I............................CENSUS TRACT ................. ..._.. Owner's Name ........lQ-t��-.-._ -4-3 oe ..Phone .. .. ............. Address . ata- .-.-.- � '. / 4' City :-+0.� ......... _.a Contractor's Name .- .....---..License# P.2-S'541 .3. Phone ..i•��a��,� Installation will serve: Res denceXApartment House Commercial OTrailer Court 0 � VIi Motel 0 Other_ i Number of living units:_/------- Number of bedrooms __,t___.Garbage Grinder ............ Lot Sizei_.-�_7477�.............Water i 5E - Supply: y .Private ❑ Character of soil to a depth of 3 #eet:� ........................................... , Public stem an na' p ii► Sand El Silt Q�Flay 0 Peat 0 . Sandy Loam Q Clay loam 0 w Hardpan ❑ Adobe ,-Fill Material ..:......... If yes,type..'........... ............ E: f lPlot pian, 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,) ; PACKAGI_ TREATMENT [ SEPTIC!TANK ] Size................................................ Liquid Depth ..........................s , Capacity -----•-------------- Type -----------A ..... Material------------------_- No. Compartments ......................0 - t4 rw ti [ } nearest: Well ............................../.."Foundation ..--......__..... ... Prop. Line . Distance to � _ _ , --- Length of ach fine---.... .-.p Total Length LEACHING LINE No. of lines'' --/---.------ � --------�--- -- ....,�....................+� H H`+ /9 r 'D' Box .. Type Filter Material .4fC- l Depth Filter Material {.:- , ........I................... Distance to nearest: Well -.. crx? --._ Foundation -.-�Q.......... Property Line ....� .�............ SEEPAGE PIT ( j Depth ___ ._-. Diameter Number ..........1--------- --._ Rock Filled Yes r Water Table' De th -, ------.•-- -Rock"5ixe YS� `.I, Barest: Well � ...............Foundation .-_ ......_:.. Prop. Line ..tiS�. ...... REPAIR/ADDITION(Prev. Sanitation O. 4 Distance to n ermit�# -•- ..................... = Date .....--•-- ......} .Septic Tank (Specify Requirements ------------------I -- - { Disposal Field (5pecify Requirements} ...._.. --------- --.... ...... " dl� � ._�-------•-------- •--------•.... ........... .............................. �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, an&'Rules and Regulations of the San Joaquin Local Health:District, Home owner or licen- sed agents signature certifies the following: - certify that in the performance of the work•for whlch�lhis permit is issued;I•shall not employ any person in such manner as to beco a object-to rkm n's Compensation laws of California." Signed ---- ------ Owner By --------------------- ....... Title c.�,r�.. .-.. (I other t owner) , — _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY , ••---• - -- ------------ DATE.... -- - / .._77..: BUILDING PERMIT ISSUED -... ---• ..----•-------..DATE ---- .. ................................... ADDITIONA COMMENTS ----------------- i ` --- ------- •---- --------------------�---. -------------- Final Inspection by: ..............•--•--• -K7h' EH 13 2h 1-6i3 . � � JO IN LOCAL HEALTH DISTRICT $ 3M t f�