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•r FOR OFFICE USE: APPLICATION-AOR SANITATION PERMIT ..................................:............. :. (Complete in Triplicate) _. . _ _ ., Permit No. ..; . issued :77 .............. This Permit Expires 1 Year From Doh Date issued ----"•_--.. Application is hereby made to the San Joaquin Local Health District for a permit to constrict 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_ .._..:.Y;.�.J^---4.-/j.1------- f... _ f ` .�.yp...,,..CENSUS TRACT r Owner's Name ....._ 6. 4-•T� . �' �.Q..._�f.='-.Q.�.�-......................................................................Phone .. ..�...� Address _-_ (�_'----_ Q.?l ,p w Contractor's Norrie ...License # ............... ..._.Phone Installation will serve: Residence JKApartment House 0 Commercial OTrailer Court O Motel ❑Other iF Number of living units.---- Number of bedrooms ....G arbo a Gr€nder tot Size _A0 F. �.... ` - Water Supply: Public System and name ... : .............. .................... ........._.......`...........-----......._ ..Pr€vate(� Character of soil to o depth of 3 feet: Sand t). Silt❑ Clay 'aPeat❑ Sandy Loam X Clay Loam ❑ Hardpan❑ Adobe ❑ Fill Material ....:.......If es .....*......... ...I........ " yes,type (Plot plan, showing size of lot, location ofsystema€n relation to wells, buildings, etc. must be placed on reverse side .) NEW iNSTALLATION: (No septic tank or-seepage_pit perm ittedlf public sewer Is available within 200 feet,} PACKAGE TREATMENT [ I SEPTIC TAMC �.�_...,� . Size................................................ Liquid Depot .................... --- 3CJ S�� Capacity _.. �..._.• TYP$ = ...-••-------• Material. No.No. Com rtmerrts . ---- I. s. • .101f Cc, cI'ele., Distance to nearest: Well — -•..... ...................Foundation ...-............... .. Prop. Lind. LEACHING LINE [ ] No. - ' � r a# Lines .._._.__._..--•---:__- Length of each line.-... ................_... Total Length ...........,................0 'D' Box ............ Type Filter Material _....Depth`Filter Material .......... < -b Distance,to,nearest: Well..:...................... Foundation ..._............_...... Property Line ........................A SEEPAGE PIT [ Depth -------------------- Diameter --......__.. ... Number ..._._`....----........... Rock Filled Yes ❑ No �]1 ----- s t Water_Tqa le Depth .............. •-•-••...........................Rock Size .------------ .......•••--...... � Distance to nearest: Well . '` ' --....Foundation ............ Prop. line { REPAIR/ADDITION(Prey. Sanitation Permit ---•---_-------•-•--•------•--•- ........ - Date ........... ...s:___.---------,} Septic Tank (specify.Requirement s1 ---:..X&5 r .--- ?¢ V... l�J---• /'� Disposal Field (Specify Requirements) _..&,XL-F�i_'A7ZF.__-- - - - •• - (Draw 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, and Rules and Regulations of the San Joaquin Local Health,District. Nome owner or liter- sed agents signature certifies the following: "I certify that in the performance f the work for hi this permit is issued, 1 shall not employ any person in such manner i as to became subiec askm s Ca s of California." Signed .... -.. 4_01 Chaser By ---• ------------------------------------ ......................................... ,.-..-------------- Title ------ •------- (If other than owner) ©EPARTME. USE 9NLY I APPLICATION ACCEPTED BY - .: .... ... ............ .DATE _ ., _. . BUILDING PERMIT ISSUED __.-------- // ) ADDI�NAL COMMENTS ts+s -C?kf�t � .p .. .._ DATE 4 --- -------------- --- ------ -- ------ -------------- _._..._. _. .. -------------------- ----- -----------•------------ -------••----------------------------.._..._...-•--------------------- Fina! Inspection b •------------------------------------------------- y: ---•• c� -------••---•--------------.- --......._......._._...__..._Date / - -.. . Elf 13 24 1-66 rev. AT '--... ..... -- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M `� a N