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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT ................................ .............. (Complete in Tclplicate) Permit No. 77/ -•---•..............•-...............-•---............ . ---- Date Issued o.2.-2- 7 This Permit Expires 1 Year From 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 ADDRESSAO N �J�_ [� �C ...�?C.....�._../5-.-�---�_.C.�/_.�/.�t1.---.._�.��. .._ �:!'L�.:...�...CENSUS TRAGI .......................... Owner's Name ----M, .�................................................. :........... Address 7.- ,� t.r ..City 112§,1 f fn. .. - .................... Contractor's Name ..-------------- =--------------------------------------------- .....................License # ---- ......- .... Phone --•------•---• -------------- Installation will serve: Residence(29 Apartment House Commercial❑Trailer Court 0 Motel ❑Other.......................................... Number of living units:..__.... Number *f bedrooms _-----Garbage Grinder 45.•.- tot Size f — � ! rn� - --•-•- Water Supply: Public System and name .1:_1. 1/m 1.�0/1-_ ..Private . Character of soil to a depth of 3 feet: Sand Q Silt 0 Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan Q Adobe 0 Fill Material ............ If yes,type............... ............ t #Plot plan, showing size of lot, location of system,in relation to wells, buildings, ets, must be placed an reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ IC TANK; } Size....... �. .�.._� ._.__....--••---... Liquid Depth .---�":--------•-----•--- • __�� X11 IS 7� papaf �?. Type .................... Material.L,,��rrh-•.h!/r—No. Compartments ........... .......... .Foundation �........ Prop Line /Q aG... Distance to nearest. Well LEACHING LI E [ j „ No. of Lin s -------1.......... � Length of line........-7-��_......._. Total Length f�......................... D' Boxc• Type .Filter Material4I0712.Depth Filter Material Property Line - Distance to nearest: Well Foundation ._....1......---- �.`�.......•. SEEPAGE PIT [ j Depth .................... Diameter ........._:..... Number ------------------......... Rock trilled Yes ❑ No Q Water Tcible Depth ................................................Rock Size ............................... Distance to nearest: Well ----------------------------------------Foundation ---- ............... Prop. Line ...................... REPAIR/ADDITION JPrev. Sanitation Permit# _ ---------------------------------------- Septic --� Date ............................... -- --- Se tic Tank (Specify Requirements) ..... ....) , ....0/�I� E�E[> t ...... Disposal Feld Specify Requirements) ... - .j2.1 ...�_......... "- ...•..._..---___" ...... -••"-- _ -------- ... ----�'fi- ---lir-- ---- ---! 6 - (Drow existing and req !red ad !tion on reverse side) 1 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 tho Son Joaquin Local Health,District. Horne owner or licen- sed agents signature certifies the following: 111 certify that the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to ----- Tact to Workmaq;�Corn Baliwner Signed `` �"!✓ s ws o California."Ca iforn BY -•------------- ---------------------------------- ---•---------------...-•-•-�------•----•-•----- Title -------•---- --- -------........... lif other than owner! f DEPARTMEN USE ONLY - APPLICATION ACCEPTED BY _"-lit/_ ... ........:........ •------------ - { --•-------------- DATE '."�.2"�,��....------- 1 BUILDING PERMIT ISSUED --------------•"- . DATE ADDITIONALCOMMENTS .---------------------------------------........... . .......•.............................. .•--------------- --------------- •---- •-------- ..,-----------------------------------................................-----------------•-------...................... /` -----•-------•---------------- --------- Final Inspection by: .. Date ":.'7..7 '... "._ U 13 2h 1--68 Rev. 5m 3 � SAN JOAQUIN LOCAs: HEALTH DISTRICT 874 3M