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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .---..._.._............................._.. (Complete In Triplicate) Permit No. ---...--.....•....... 77 ................................ ------------ This permit Expires I Year From Date issued Date Issued ..0................ 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•.._...-•-a/�.75 �tJT/e `,y.= 1 ................... .....0 - ..._...... ....._ / ENSUS TRACT....... Owner's Name ......_. ` - .!tl_�eJ!'�..- i..(6..................:.. Address . `y_...r....... ....... S one ` Ph .... ................. � .x _. ....... c, f Contractor's Name ------------- i .----- • -_--License # --•---------------••-•-- Phone .............................. Installation will serve: Residence Q Apartment HouseOCcnimercial[(Trailer Court C] Y Motel❑Other--- •-------- Number of living units:-.---/----- Number of bedrooms ----/.....Garbage Grinder _--_--__---- Lot Size __-_ ,_ c ................. Water Supply: Public System and name :..•--_._. - . ,, p -----------•----• ....---------...-•----=---•-----•-- ---Private ❑ �1 Character of sol l to a depth of 3 feet: Sand ❑ Silt[�, Clay .R) Peat❑ Sandy Loom [] Clay Loam ❑ Hardpan [❑ Adobe El FII) 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 200 feet,) F l PACKAGE TREATMENT { ] SEPTIC TANKSize.- --- - - =----- ..........................• ..... Liquid Depth ...................... � ) Capacity .'---------------.... Type -----Material-------..__--__- No. Com _ Distance to nearest: Well -------------------------------------Founda#ion -------------- ....... Prop. Line ................. LEACHING LINENo. - [ j No. of Lines ........................ Length of each-'line.-.•___....____....___....... Total Length Box'D' � Length ....................... --....._.... Type Filter Material _--.-__-...Depth Filter Material .. Distance to nearest. Well . Foundation _ _, "' 'Property~Line a SEEPAGE PIT f 1 Depth Diameter .... Number ...................... Rock`Filled Yes ❑ No C)Water Table Depth .............•----....---•- ....................Rock Size _..------------ l Distance to nearest-Well ................ Foundation -------------_---_- Prop. tine ..........I........ REPAIR/ADDITION(Prev. Sanitation Permit# ............... ...........................- Date ......_-------------------------- Septic ----------,--._-------__ .Septic Tank Specify Requirements) ....................................�� - Disposal Field (Specify Requirements) ..ZAQ......-- -( - �'' G.. _. ----- ----------- ------------•--•--- --------••-------•--- ----------• ----------- --- ---- •---•---------------•---------- -------------__- ----------•----------------- . t(brow 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. Horne 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 shaft not employ any person in such manner as to become bject to Workma •s Compensation laws of California.- Signed cx " •-- ----•-------------•-•----------. Owner . icy --------------------------------I-------------------------------------------------------- . litle ........................ '(if other-than owner) FOR .DEFT T ENT USE ONLY APPLICATION ACCEPTED BY . DATA .. �� ---- BUILDING PERMIT ISSUED -------------------------------------------------------------- ...............----.....----------------- DATE ................................ BUILDING COMMENTS . .............L_------_-• _-- - ...........................-.........-------_------- ------•............................•................ ---------------- •----- ----•---.... ..----------- ..........._..--------•........ . ----------- ••--- _ Final Inspection b P y: .-.- -----------DateEH .:. __ _... 13 2h1'6 SAN JOAQUIN LOCAL HEALTH DISTRICT $!74 3M