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FOR OFFICE'USE: APPLICATION FOR SANITATION PERMIT �/ q .9 :.............•-...._...._.... ;....---...... (Complete in Triplicate) Permit No. .. _T�.3l. -._•-- This Permit Expires 1 Year From Date Issued Dote Issued 3 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 complicnce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC ON , • � ...... . ....... ..... .................... CENSUS TRACT .... ..................... Owner's Name �._._. � Phone --- ........... a • Address ....................a� 7Q1.. - ......... City ----.. ._.Pyr'` - -..................----• -•------....... 6 `;_• Contractor's Name .... /A -s.P i ----• - ... ,.---.....License # � -3 .. Phone .`._:._...___.- Installation will serve: Residence ❑ Apartment House❑ Commercial❑Trailer Court ,❑ Motel ❑Other Number of living units:...___�__._ Number of bedrooms ...._Garbage Grinder .....,...... Lot Size .476!4—.'_ ' ------------•- Water Supply: Public System and name --------------------•---•----._............................................. ----------- ...................Private Character of soil to a depth of 3 feet: . Sand Silt❑ Clay ❑ Pe-at❑ 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.) Q� NEW INSTALLATION, (No septic tank or seep ge pit permitted if Public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK Size..Y ./l .�..� _5______________ Liquid Depth ..fi1.................. Capacity lclw-.y ._ Type _ Material--- No. Compartments - ...... .... . " Distance to nearest: Well ..__.......,7ez_._.._..__.:_-•--Foundation _.."4>............ Prop. Line .....�F_•- ........ LEACHING LINE [ No. of Lines _._....Y......... Length of each line:----------4r0_ -------. Total length _ © .......... 'D' Box ..... Type Filter Material _---- A........De'pth ,Filter Material ../_�e'. ................. . _. Distance-to nearest: Well ....__._ ......... FoutTelation ,10............... Property- Line .................. SEEPAGE PIT [ Depth '..__.___ Diameter .... Number .......rte.............. Rock Filled - Yes LSI No 0 Water Table Depth fa ...._.......Rock Size _lam--�. ' .......... I Distance to nearest: Well .......� �J.....................Foundation ._._/Q.....__ Prop.. Line .__..._......_ REPAIR/ADDITION JPrev. Sanitation Permit# __..............-------------------...... Date ..............._._. .............. SepticTank (Specify Requirements) -------.......................-..-......................................................................._......................... ....... { Disposal Field (Specify Requirements) ...............- -----.........................==...... ......................... .................................... --------------------------------------- ---------------------------•- .............. •-•--------------------•. •-- (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 i County Ordinances, State Laws, and Rules and Regulations-of the Son-Joaquin Locale Health District:-Hama owner or-lican- serf agents signature certifies the following: i "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." r Signed ..'-.............. Owner B �� Title y ...----- (If other than owner) , l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._. = ------------ ----------------•---- --------------- DATE e$7 -_X BUILDING PERMIT ISSUED ............... .......--...........-.................-.............__--....__----.-_-_ ----.........DATi: ADDITIONAL COMMENTS ................I........------............ - :...._.. . .- ----•- Final inspect..... `:......._ ..._._..__.. -•--•• •......._ Inspection by: .. .................. Date c ` A . SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H.13 24 1-'ea Rpv_ jAA . \ `7//79 A .v