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APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .77-23,P ........,..................... ........................................ This Permit 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 is made in compliance with County Ordinance No. 9 and existing Rules and Regulations: JOB ADDRESS/L AA ON ...a.(+..94.�-5-,o 4 1, 14#4 ivs A) CENSUS TRACT .......................... Owner's Name ..7.1�.�� d ;� ----- .!s'd- - ------ Addressh — . 3 3 ,9•v t . . .. ........ uy Contractors Name -----lf-7wN.P_6------- ---------------- ------ -----------------.License #I .. ------------ Phone ----- ----------------- installation will serve: Residence®Apartment House❑ Commercial❑Trailer Court ❑ Motel ❑Other ........_. ....................... Number of living unils:._:..-._. Number of be _-. ._...Garbage Grinder ............ Lot Size .---g_.19P'______.._.___.�_� Water Supply: Public System and name ..._. -�-___--_.._------------ .__-_Private❑. Character of soil to a depth of 3 feet: Sand Q Slit❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 5M 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 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size-_-_--_.........:.. ..... . Liquid Depth ..........._.... �.._ . C0pacity1P00 f F,&ype -------------- - Materiat.P.Yu-tik[�.t�No. Compartments ---2 j.._ Distance to nearest: Well ...j�.......................Foundation � �.__......-_. Prop. Line __4 ._!__ .... LEACHING LINE [ ] No. of Lines . �.-___------ Length of each line----------Flo Total Length .9, -W........... _ 'D' Box ..__/.... Type Filter Material �pth Filte�aterial .......t/7sQQ.................. _ Distance to nearest: Well .IQQ ,...._._ Foundation Ze--------------- Property Line _1161-V.......... SEEPAGE PIT [ ) Depth ----_.............. Diameter ................ Number ........._..._. ........... Rock Filled Yes ❑ No O Water Table Depth ........................ ......._..............Rock Size --------- ------------...------ Distance to nearest: Well ........................................Foundation _._............ ... Prop. Line .................... REPAIR/ADDITION(Prey. Sanitation Permit# ----- -------------------------------------- Date .......-.........._...._..-----I. Septic Tank (Specify Requirements) ,...-- ............... ............---........_..........•--_-...............-.................-----._.......... _..__.._...:. Disposal Field (Specify Requirements) - - - -----------•-----•-•-----------•--•-••--------------•• ---••----•----------- --•-----•------ ---------------- ----- ------------------:.--' -------------------- ----------............•.........------ •--..____..._.........._._....._.... (Draw existing and required addition on reverse side) 1 hereby certify that 1 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: "1 certify that in the performance of Otpwork for which this permit is issued, I shall not employ any person in such manner as to beco,ub( t to 71cman's mpens ion laws of California." Signe? "' - --- Owner h By -------------------- --------------- - ---- ----- ------------.--... - -------- ----------- Title . . ._.. (If other than owner) FO P { ENT USE ONLY APPLICATION ACCEPTED BY .--- _ - -.---...--- -- --.._----- ------------- DATE -- 1._---- 7----- BUILDING PERMIT ISSUED - - - ------------------DATE .._.....---- --- .._..-..... ..... ADDITIONAL COMMENTS �, a...... -------._-----_--.- L - C. _ ................ . ... ... n Finaflnspectionby _.. - _. � ... ... . . _ . . . . Dot .................................. EH 13 2h 1-68 Rev. /SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M L