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T FOR OFFICE USE: ' IS14 �6 _5.76 APPLICATION FOR SANITATION PERMIT , ........ . .............. ��_� a 2p //-7G C 2,( -o (Complete in Triplicate) Permit No. ....... .. .. . •........ ..................__° ...�. art • This Permit Expires t 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- JOB ADDRESS/LOCATION 1-r.2-S-7 .5,' . . . T ................................. Cw Owner's Name - ►�.f.II-�.. .. 1 ........,.�.7!.LL., ..�4► Y......................................Phone Address / t ' .,f- iS.� _ /�f�1r. ..4M�. .1iAl..d!► .............. City .. ,/ .�a!l 1L.�..C..'4................................ Contractor's Name ..........6.7 7W.4V -. --......-•.....................................License # ........................ Phone .............................. Installation will serve: Residence 1111partment House❑ Commercial ❑Trailer Court Motel ❑Other ............................................ Number of living units:..4j.---- Number of bedrooms ...I- ---Garbage Grinder ..X - Lot Size .....!'...AC*f-ICALr...... Water Supply: Public System and name .---•--------•-------•---•-•---...._.....-•............._..................•---..............................Private Character of soil to a depth of 3 feet: Sand Q0*Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam ❑ Hardpan Q Adobe ❑ Fill Material ............ 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 perrrtitted f public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I ] �� j ........ � � ! ............ Liquid Depth .......................... Capacity Y -------------------- Type --•-----•-•--------. Material..--•------•------..._ No. Compartments ...................... Distance to nearest: Well ....................................Foundation .`................... Prop. line ..`...................J LEACHING LINE [ J No. of Lines --------- Length of erch line........Z.C�........-_- Total length ....�..,�. ..(...... � r o 'D' Box ------------ Type Filter Material l:1 .fll--Oc&epth Filter Material ...... . J..f............. .. Distance to nearest: Well ....16--0.1...... Foundation SO- Property line .....60 .......... ........ SEEPAGE PIT [ j Depth .... ........ri 6 _. Diameter _X.2.f Number ...... ./'I/L"......... Rock Filled Yea V No ipV Water Table Depth ...-------e-.......................•---....Rock Size ..... t�. ,.......... �� Distance to nearest: Well ....1_(_.4..........................Foundation .., .Q........ Prop. Line ...,�.��. ......7 e REPAIR/ADDITION(Prov. Sanitation Permit# ......._..........................._....._._ Date --••---•-- ................... Septic Tank (Specify Requirements) addA&-o -' U.....,�� ..•--. .-- - Dis Disposal Field (S -�-�- ��„a �°' '-•.. p (Specify Requirements) . ; -----•-•------••.... - .f�� %f� ...---- ...................... "v "� �`�" , .ems' Gti^ceti ---1 ------------------------------_..............----... ....... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done lin accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hearth,District. Nome owner or licen- sed agents signature certifies the following: "I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in such manner as to become subject to Workman's Co ensati n laws of California." Signed v 't�i .. -- - Owner By --- -- ----------------------------------------------------------en ) ------ Title --- .. ---•--. . ........ (if other than owner) FOR DEPARTMENT USE ONLY ---77 APPLICATION ACCEPTED BY .. . .. . . ......... DATE /�.-..✓...'-` 677 BUILDING PERMIT ISSUED ...-- --� -- ..... ---•------• r ..... DATE ADDITION&L COMMENTS __ _ - ._- . ,�,5 ------------------ ------- - 4. ---- --------------- ---- - - ----- ...... .. ....... --•----- -----. . .. --..-... _----- . Final Inspection by: -. �� ! ...---•----•---•...------. . . .............Date -�"-1 -7. ............ 13 2a 1-6£3 v• SAN JO UIN LOCAL HEALTH DISTRICT 8/7h 3M