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,4�KC-_ OFFICE USE. ��( APPLICATION FOR SANITATION PERMIT 7� 3i � 71- ............ Permit No(Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued . ................ i j Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein J described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: J08 ADDRESS/LOC ION CENSUS TRACT Owner's Name .-:. .. 4-C- cr+.��................ ...-----...---•- Phone. Address .........:2-..33C� - - r Cit Contractor's Nome ... ---..?fTs?-�1----------------License #w-.y..j .7�. Phone 546E -9607_ Installation will serve: ResidenceVN Apartment H##ouse❑ Commercial ❑Trailer Court I Motel 0 Other .-..•.ti°.. p_-...--._ Number of living units:........... Number of bedrooms ...'.:.Garbage Grinder Lot Size ...- Water Supply: Public System and name .........................- --------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy'Loom ❑ Clay Loam j] Hard pan-❑--Adobe--Fill-Material .... _ ......... ......... N (Plot plan, showing size of lot, location ation of fsyste'rr)�in elationjo wells, buildings, etc. must be a fploced on reverse side.) NEW INSTALLATION: '" ' "4i ' j (No septij;tank�r�seepage_pit,.permitted.,.if_public.sewer is available withi� 200 feet,) �I PACKAGE TREATMENT [ ] JSEPTIC TAN�� Size.-------_....---...........................Liquid Depth ...................... .... Ca acit 1 p Type --------- ---•--.-. Material.---- No. Compartments ...................... Distance'tb.nearest: Well . .... .......... .---------...Foundation .............. Prop. Line ......___....... LEACHING LINE [ I - No. oflines length of each line.........,.- Total ,Length ............................ 'D' Bope-F`l'ier Material --------------------Depth' Filter Material ... ..---._....._....--.------.............. Distance .to nearest: Well -------------- Foundation .. .�----------_..._. Property line ........................ SEEPAGE PIT [ 1 Depth .l --------- Diameter -----_---._.--- Number Rock Filled Yes ❑ No ❑ i Water,Table Depth ........ . ................. Rock Size _.... .-.. 1 Distance to nearest:�Well .._::?.._ ..�---------..-_---------Foundation ....----.-- -- ---- }Prop. Line ...................... REPAIR/ADDITION Iprev. Sanitation Fermi# '_+_-' ------ Date -- -------------------•----•-----1 Septic Tank (Specify Requirements) ---------- �-�-� --- -------------------••-- Disposal Field (Specify Require eknts) ..-._ �-- _ --•.-.....t•_:.csiGiu:aiiJla'..' ...A...ur ... ...............................k:�.......... ...........-_•__-....--.------------- --------- -.-----------------........... 4 (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the ,work wild be dons in accordance with San Joaquin County Ordinances, State Laws,°land Rules and Regulations of the San Joaquin Local Health District. Home owner or liven. i sed agents signature certifies the following: ` "I certify that in the performance"of"the'woevfo r which this permit is issued I shall not emjaloy any person in such manner as to become subject totlWorkman's Compensation laws of California." t"f 1„_.�..__ Signed .:_. . ... I ± ----....... Owner - -•-------------- By ...: -- •. . . . .. n _. ---- --- -i . ....---- Title ......- i ll oth an owner.`'• <t .. a R MENT USE ONLY f •� APPLICATION ACCEPTED BY -1� ................................. DATE ! -: ._. .. ........... - - )------ ------- - --- .......BUILDING PERMIT ISSUED ....- .. --- .. - - - - - DATE . .;_. - ADDITIONAL C ME TS ... ... ........ :'. ..-- �f�-•---- ----------- ¢ - Via.-.�.�� ..�.. ` .. a r -t..c ._... _._. - ............... -------- _ . _. .._ __.- ...--. .................... ------------- ............ .......... .. .... ....-_.....---' /� Final Inspection by. -.. = * 'f � - -----=--------- -------Dat SA JOAQUIN CAL HEALTH DISTRICT �tp, `V �E_ w_ 13 241--Aqv.- sAA 7/77-'7.0 �. t