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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit No•__77`k6_ --- -------------- --- ------- --------------- ---1A------- Date ,lssued/ y- 7 This Permit Expires 1 Year From Date issued --------- 7 - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.' This application4is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _. JOB ADDRESS/LOCATION _4 ........... ^ t vt�-.- N 7� /� ----------------- ----- --- -4.....CJ SUS TRACT Address-----=----- -- r • _ Phone..__ F Owner's Ndme_:_.-_-__- _ City = = ------------------------------- Zip---= �-p,S^ Co' i!---- ntractor s Name = License #------ --- Phone --------- -R Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ = v, ... ..... Motel [] Other-- = I - ------ y �7 � ^-i = Number of living units______ ____Number of bedrooms.:_-„_ Garbage.Grinder.-__..._,._.Lot;Size-__...`_: ...__-= -.-----l = ;. : .. PP Y Y ?----------- ------------------------------------- i p...� 1---------Private Character of soil to ci pOe th of 3 feet: I ater u Public System and;nam Sand ❑ -Silt❑s' 'Cla�r�❑ , Peat❑ Sandy Loam ❑ Clay Loam ❑ l i Hardpan ❑ Adobe E ': Fill Material.__ . If estYPe___'---------------_-_---- ---- Z. ---- (Plot plan, showing size of lot, location of sysfem 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 'SEPI IC TANK Size-._' --- I_a D c)-.. - i h J / K - --- -- Liquid Dept _, - -- -------- ' 1` ¢ —Capacity� w_c -`TYPe .-!Ls ---Materialr,.cr_�lP-----=-No. Compartments ---.----- --- , z r - �I _ H .Distance to nearest: Well”" f Q --------- ---------.,--Foundation_----1Prop: Line--:,--------------------- --------------- ------------------------- LEACH ING LINE•: �(], No. of.Lines-'----',T:- -._Length,of each line, . �� Total Len�th --- D' Box :..Type Filter Materia(�?�//,AnADepth Filter Material-- _.- -AR....,fU,c_rf_�___ Distance to nearest: Well-___ __ -___Foundation__._-_ . �l__ _____Property Line "-Z ---- r i Depth._ - -6..XNum e --= ockied'; ; Yes No r Water Table Depth. >✓-Q1'f- Rock Size------- -------------- # Distance.to nearest: Well._.._ _.. -_Foundations P e�} I -- r Ir REPAIR/ADpiTION (Prev, Sanitation Permi# _'._:_- • _:._Date_-------------- .k_ ro i < Septic Tank (Specify Requirements)-=---------- -- _•:__ ' - ' Disposal Field_ (Specify-Requirements]-_----------------- ---- ---- -- I E. - ------------------------------ - -------------------- - ' - ---- - i ! - -------------------- ---------------------- 1 I (Dr"aw -- ---------------- - = `------1-------------=------------ ------ - exisng and required addition on reverse side] I hereby cert(#y that:E have prepared Fhis'application and that the work will be-done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sari Joaquin Local Health District, Home owner or-licensed agents I signature certifies the following: ; �.. certify thaAil t in the`performance of;the'work for"wliich this permit is issue F, shall not employ any person in such manner as to becorRe subfec to ork' a Co .pjensat��aws of California." — i d 'Signed_. ..._ i -- _ 1- �` - ''" r`�.._ I Y wn e BY = _,. Title ------------------- Of }.. other than "owner) _ .. ; _. ., 1 F DE RTMENT USE ONLY } r APPLICATION-ACCEPTED By--.-- p (V .!r� - ---- DATE ------ - = 7 li DIVISION OF LAND NUMBER. ---- ------ ------------- ----------- l ' DATE - - ----.- -..,. , - ' ADDITIONAL COMMENTS..-_------------- ` ---- �� --------- --------------- ------ ---------------- c ----- - ------- ----- ff 77 --- . -- ------- --' t Final Inspection b - ___ ----- ------------- / / _- " -8- =7__ = Date = a 1 .77------- # EH ]3 24 SAN JOAQUIN LOCAL. HEALTH DISTRICT F85 21677 REV. 7/76 3M