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FOR OFFICE USE: `S '77 y�7 ................. ...................:�•.�..._---- APPLICATION FOR SANITATION PERMIT 7 'Fi (Complete in Triplicate) Permit No. .......... .........................I............................... .2- 3- 7f .......................................................... This-permit Expires 1 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 --. /D... - _ ........ Ar-�..i �� J�. ...CENSUS TRACT Owner's Name ' .4.P IsJ.f.,s......................................................Phone .......................-........... . Address l D..�.1rr �i. °�..�. .C./ >� f-^_ _�.........A,vz..City .....MA IV-7-e-61........................:.......... 4"r" Name ---�d A-.lel./ -D.!�1---_(2�_......._.i _LL i...................License # Phone Installation will serve: Resldenci KApartment House❑ Commercial❑Trailer Court ❑ Motel [3 Other............................................ Garbage Grinder Lot Size _...f.. Number of living units_____________ Number of bedrooms .__. .....- ...._....... .... Water Supply: Public System and name .....__...-•..................._.---..................-................................,..,...............Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loom V� Clay loam Hardpan❑ Adobe❑ Fill Material ............If yes,type............... ............ {Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size--------------------------- ... Liquid Depth ............................ Capacity - o�Type .................... Compartments .,Z,. Distance to nearest: Well ..... DV.................... .Foundation .AV.`........... Prop. line ../-. ..........O ....-•-.•.-__ Length of e0, Ile,....-y� Total Length LEACHING LINE [ ] No. of Lines ng � ,.................. ..st.-:.. ......,..... 'D' Box ............ Type Filter Material .1S`Q C1 __.Depth Filter Material ........ ..................... Distance to nearest: Well _.10Q............. Foundation ..... ................. Property line . .d D ...... SEEPAGE PIT [ ] Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes ❑ No i❑ WaterTable Depth ........ .......................................Rock Size •-•--•--......._......... ...... Distance to nearest: Well ...Foundation .................... Prop. line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ................................_.._...._... Date .................................. Septic Tank (Specify Requirements) ......____................................................................................................ Disposal Field (Specify Requirements) ....................... .........__...._.._.........._....... .................... .....•----•----------------......----•••-----•--•---------------•••-••--••-••---••-•----•---.......•--•-•...........•••••.....-•••--•••••................._................ ............................................... ..............------- ......................................-......................... -•---......................._._...........---..................... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Jo"uln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Heallir..District. Home 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 ub[ect to Workman's mpensation laws of California." Signed _. - --'-4,-44A.cif............................ Owner By ----- ----------G%-- ----------- •------- ............. Jitle ..----- ------------ ......................... (If other than owner! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----.-- --- L-------- . -------- Lr .......... ..... DATE Z �-3- --7&------------------------ BUILDING PERMIT ISSUED ........ ...... �/ a...___... ...DA .................. ADDITIONAL COMMENTS ........ r '?!t '.'. c �a..----. ..51�.. ........................ -------------------• . . ................... -----.__. .................. -------------- --------- ----- ...... ....... .. .... _.... _ .................. -*............. .... Final Inspection by: .. - __ �.:.---. .....__-- Date .. ....--... -- EH 13 2!i 1-613 Rev. SAN JOAQUIN LCL HEALTH DISTRICT 8/7a 3M