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f FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ............................ Permit No. .._77_-: � (Complete in Triplicate} ..............................•-•--•-••...._. ___._.... This Permit Expires I Year From Date Issued Date issued .y .� :. 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .._.:.._. .. - -- __.:. . .. 0-!V... r. fF ._...CENSUS TRACT ..........:...:.... Phone 's Owner's Name .-- ............IN__ ��.... . .y 5 Ase:--------............................r-............................... ..._. �.�...�!�:��........ Address ....................... acr ..•--••---•-••--•-.................................. City . D` ? '`.a .......................... ......... •...............License Phone .... # ,3 ... . � z:.t..._ Contractor's Name ........... .'.�.:t_ .f.��-�?�F�...-•.---•-- ---- Installation will serve: Residence Apartment-House❑-Commercial OT-railer-Court 0 Motel ❑Other ............................................ Number of living units:..../...... Number of bedrooms _3_.:_#tGarbage Grinder ............ Lot Size; ..... .......... _i........ Water Supply: Public System and,name -----•----------------- .-......_ -----------------------------------------------------Private Character of soil to a depth of 3 feet: Sand L] .. Silt❑ Clay ❑ , Peatf] Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe; . Fili Material _N___--___ If yes,type -------•----------------- j (Plot plan, showing size of lot, location ofsystem in relation-to wells, 1 Ziddings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic•.tonk or seepage pit permitted if public sewer,is available within 204 feet,) ' { PACKAGE TREATMENT [ ] SEPTIC TANK j Size................... ------ Liquid Depth .......................... Capcicity•�,._�.,._..e____..._ Type ----------------_.. Material______________________ No. Compartments Distance to:. nearest: Well ............. Foundation ................L_.__ Prop. Line................. _.._. LEACHING LINE [ ] No. of Line$................:....:.. Length of each line".' ----------- Total length ........................... -D' Box -- --Ty�S� Filter Material ....................Depth Filter Material;-------------_---- ------------_---_- -_bo � Distance to�nearesh'Well ......................... Foundation -77............ ------ Property Line SEEPAGEPIT Depth Diameter .......:........ Number ............................. Rock Filled Yes ❑ - No.-gym Water Table Depth_ .....---•--•................•--• --..........Rock Size -•--•-•-•-••-•--- -------•• �. 5 � Distance to nearest: Well ....: ...........:.....................1 oundation _____________ Prop Line .... ______ _.... t _ 4 r REPAIR/ADDITION(Prev. Sanitation Permit# Date . ) `1 Septic Tank (Specify Requiremen'ts') ._... _.pp----------------•..-'--f--...:.f•---------._.....------ ............-......-••...._....... _..._._.._ -r# Disposal Field (Specify requirements) ............... _ _ 3____.P4 .. ,.'__ -f' t� ----------------- ----------------------------------- ----------------- _._... _ __...74. .................... ' ti' .I! _ ; ----- {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 signature certifies the following: "I certify that in the performance of the work for which.this permit is issued, I shall not employ,any,person In such manner as to become subject to Workman's Compensation laws of California."- n Signed Owneq BY r.. . - .._. _: _ _ Y. `:! ---,............:..... . TitEe : :......... .................. F (If other than owner) : FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... ... DATE .... a-� - ---•--•••---• .................•-•--- BUILDING PERMIT ISSUED --- ----- --••- - DATE .l................. ADDITIONAL COMMENTS -- •-�-�-•--••--••---- -•�-f ._.Z.. -------____ __•-1: � .......... � -�'..---•-••-'- p .....................•..•--.--.--.--..._..._. ._ ._._ . ....... ... _ _. ................................................... ._•_•._..=....... .-............... ......................................... ....... _-- ....... ._ ......................................................------..-. `...... . . -• Final Inspection by: ..__: . .. -••• ••. - Date ••- •• -• ... .. - OAQUIN LOCAL HEALTH DISTRICT '• - E. H.1.3 241.-AR SAA 71'77 '1 ,V