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FOR OFFICE USE: APPLICATION FOR !ANITATION PERMIT -------- --------------------- (Complete in Triplicate) Permit No. ____________________ ThisTermit 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 ismadein compliance with County Ordiriarice No. 549 and existing Rules and Regulations: --!_ JOB ADDRESS/LOCATION 179 -----------------,5j6Fj-1DiV_ -�_ ------- ----------CENSUS TRACT ---ate-- -•----- ~ Owners Name . -_ ---------- p �� > ` --- - --1 -=------ =---------------------Phone ---------------------------.•--..... Address ----- -- --1796-i`2 C e -- r -------- --�---------��-��_��--------=-.. City --- -`�--C-----L-0/_V----------- ---- - - - - Contractor's Name ---------10_4/h1P•A1 �� --------------------------------- -`---License # --------- ------ Phone ------------------------------ Installation will serve: Residence-KApartment House❑ Commercial❑Trailer Court ',❑ Motel ❑ Other ---------------------- -_---------------- Number of living units:--- ------- Number of bedrooms __ —_Garbage Grinder IV __ Lot Size -------------- Water Supply: Public System and name ---------------- --------------------- ------Private ' - _Character of soil to a depth of 3 feet: Sand'❑ Silt[] _Clay ❑ Peat❑ Sandy Loam ❑ - Clay Loam(. _ -- f Harrd`pan� Adobe❑ Fill Material -/-I O-- If yes, type---------------------IN ---- ` (Plot plan, showing size of lot,`location=+o_f,system'iin .relation to wells, buildings, etc.,must be placed on reverse side.) NEW INSTALLATION: (No septic`fank or,seepage jpit permitted if public sewer is av&ilable within 200 feet,) CS PACKAGE TREATMENT { ] SEPTIC TANK![ ] >�I- Size------------------------ --------___--- Liquid Depth -------------------_------ v Capacity -------------------- Ype -------------------- Material-------------------------JN Compartments ----- Distance to nearest: ell,- �_-__ '_ T_,_:{� ' }f 1 Foundation -- --- Prop. Line .- ! LEACHING LINE [ ] No, of Lines __-____- .-�ik Length of each line--------------------------- Total Length D' Box ------------ Type_ iltereMaterial ____________________Depth Filter riaf =------------------ ----------------------- Distance to nearest: W 11 ----- ------------------ Foundation Property'^Line-_.Wim_____.__._____ . V SEEPAGE PIT [ ] Depth _____________________ D ameter ________________ Number ------ _-.__--_ _ Rock Filled Yes 0 No i❑ ' Water Table Depth --- --------------------------------------------Rock Size ------Distance to nearest: . - ; ; Foundation -- ---------- Prop. Line ....___.._...REPAIR/ADDITION(Prev. Sanitation Permit# __ __-._____:• +--____ _____._______--- Date �_____ ________ ___________} SepticTank (Specify Requirements) ------------------------------------------------------------r------------,} ---------------.----------------------------------------------- f Disposal Field (Specify Requiremenfs) ------ --- --- .•---- ----� --- ---- --,� � -�i ------Pj_��---------------- _ - hh ------------FP-K--------fi-D-PL1_lp -----------fl A/vtg-6E- --------------------------------------------------------------------------- - - - - - - ------------------------------------------------------------------ (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. Home owner or licen- sed agents s' ature certifies the following: "1 certifyVatn she an the work for which this permit is issued, 1 shall not employ any person in-such manner as to becub'ec Workm o on laws of California." 1 pe patiSigned --- -------- ------ ----- J _ Owner BY -------------------------------------- ----- (If other than owner) 0' Title ---------------------------- ----------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------� -- ---------------------------------------___------------------------- DATE .... i°'-77- 7/-------- BUILDING PERMIT ISSUED ------- - -- --- ------------ --- T ------------------- ------ ADDITIONAL COMMENTS ----- - ---------------------------------- -- ------------ - �` ,4 ------ ------- - _ ____ __ _ _________ __ ___ _______ __ y_ �__ - Final Inspec -by: -- i%�i ✓�� - -Date-.- SAN Date--SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M