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FOR OFFICE USE: Y. APPLICATION FOR SANITATION PERMIT - (Complete in Triplicate) Permit No. 77�-V 6 -------------------------------------------------------- --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued - -a:P=___y Application is hereby made to the San Joaquin Local Health District for a per 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 /7,9,:`,-0-�- ENSUS TRACT --------------.___________ Owner's Namei� �R MDf1� �� ------- ------ Phone ----------------------------- Address _, X11__�/}�r1fr. / � 4«�--- City .............. Contractor's Name aj_ rs�'c�_______________________License # —Z�4Z7?---- Phone _ a_r3 _ Installation will serve: Residence ❑ Apartment House,❑ Commercial ❑Trailer Court Motel ❑ Other -------------------------------------------- Number of living units:___7____ Number of bedrooms lf-______Garbage Grinder ------------ Lot Size _12�_ �_._GC' c` _'_.. Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ 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 permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT f ] SEPTICTANK.f ] Size_________________________ __________ Liquid Depth -------------------- Capacity __________----__Capacity -------------------- Type -------------------- Material---------- ----------- No. Compartments 0 Distance to nearest. Well __________________________________Foundation ---------------------- Prop. Line .-..________.__-______ LEACHING LINE [ ] No. of Lines ________________________ Length of each line--------------------- ------ Total Length XfS 'D' Box ------------ Type Filter Material ____________________Depth Filter Material _.------------------------------------------ Distance ----_--._--. ___Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ________________.._... SEEPAGE PIT [ ] Depth _ ________ Diameter --- ----- Number ._______� __ _______ Rock Filled YesX No i❑ Water Table Depth --------- ----------------------------- Rock Size x/ Distance to nearest: Well ------1p0-----------------------Foundation Q______.___ Prop. Line ............ ` REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- -----------------------------.------------------------ Disposal ------------ - Dis osal Field (Specify Requirements) -x¢�_ __ ---------------------- (Draw existing and required ad ----- - - - --- ---- dition on reverse sidel 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. Home owner or licen- sed agents signature certifies the following: "I certify that in the erformance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become�s �OW an's om nsation laws of California." Signed --------- ---- --- - "'---------- Owner BY ----------- ---- ------------------------- Title - - ------------------------------------------------------ (If other than n RARTMENT U4EONLY APPLICATION ACCEPTED - d« - DATE ------------ BUILDING PERMIT ISSUED -------------------- - DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------------------------------------------- ----------- ------ ---------------= -------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- --- ------------------------------- - ------ --- Final Inspection by: - ----------------------------------------------------Date ,fQ-'"� T --- ------- S JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M