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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT t++=' Permit No...77:... P_.1;°... ..-� (Complete in Triplicate} •7 9 €i . x. - Date Issued... Q....... _ . This Permit Expires I Year From 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.:A9 and existing Rules curd Reguiations: { `..._ US TRACT.... "` I JOB ADDRESS/LOCATION..... 3 1 1........: ... `....�. .................... .....GENS :"'°� ' r-4 /�-[ .. ...__. :...._.Phone.._._..... �F! ` Owner's Mame..... i s a i Address................ ............ rC •_................city....... _ zi ' = Contractor's Name... .....................LicensePhone..... Installation will serve: Residence Apartment House ❑ Commercial ❑ TnAer Court% ❑ 1 r Y ; , o!el © Other............... ........................... ) 6 i kv; '` Number of living units:.... .........Number of bedrooms-. p�....Garbage Grinder...` —1 of Size..... 't Water Supply: Public System and name....... ......... ............................. ............... .. .......... Privates I Character of soil to a depth of 3 feet; Sand Silt n Clay C] Peat[:] Sandy Lbarn❑ ; Clay Loam.( Hardpan❑ Adobe❑ Fill Material............lf yes,type......... �? =. (Plot plan, showing size of lot, location of system in relation to wells, buildings,etc,must bepr ckmf 6A ro40*4 sPA.l 1 i NEW INSTALIATION: (No septic tank or seepage pit permitted if public sewer is available wit irr200 feed 0.. rf�_. Liquid Depth �/. Y _ PACKAGE TREATMENT [ } SEPTIC TANK [ ] Size..l��r �. / X..- ---•-..4..., _ ,,��_JJ__--,,tt Capacity./TPR......Type. Material_ LLQ. :`IVAJ4 . Compartments_....Z:..:....._ �� ...... .:. :I Distance to nearest: Wet!.. ..._Fwndatian....�,4'......._...Proo. Lina............ -._� .-Q....................... LEACHING LINE [ ] No, of Lines......._' ......... .....Length of each Iind,...p..,. .....r.�o tal Le _.-...Type Fitter Material...j�r�,..._.Depth Fitter Material. s.11I ••••.....• K. , Distance to nearest:Well.._•./..a- ........._.Foundation......_ .d ...Prope line... ' ° J y Rock Filled Yes❑ Na ii SEEPAGE PIT E 1 Depth.......... .....Diameter.--...........:....Number._......_.............._..... Water Table Depth.................................................... Rock Size-jr ........... $r Distance to nearest: Wali... ... . .................................Foundation.. ....................Prop. Line '.. ' REPAIR/ADDITION(Prev. Sanitation Permit#....................... Date..... ) ._...... a Septic Tank ISpecify Requirements)......,- Disposal Field (Specify Requirements)...................... ..........................._............_........ ._.... ........................ �... - ... ...................................................................................... ......... - ....................................................... ................. ................ .................................................... Y .. , -.........- ...-- ..... .... Y. {Draw existing and required addition on reverse side) I hereby certify that 1 have prepared This app['cation and that the work will be done in accordance with Son Joaquin County. 1 Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signaritre certifies the following: k..... wh "1 certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in such moaner as '. to bexome sub!ect to Workman's Compensation laws of California." ....Owner 5lgned._........ .. ....... ...... Ogg! ... .. ...........Title.. ...- ............... .................. ....-... ......... ...... (If other than owu r) FOR DEPART ENT USE ONLY APPLICATEON rCCEPTED $Y. DATE..S.� ?9,-. .7_._...:i._. : DIVISION OF LAND NUMBER... ...... . ... DATE .. .... .. ... ....`-.�Y. ....... ......... ADDITIONAL COMMENTS . .. I r4 . . . ................ ........ ........ ... ... ........-- C.t.� ' P.......... . ..... . Inspection by: ..... _. ........................................... . ... Date...... � ..... ................. Final Ins ..... �- EH 19 71 SAN J7AOUIN LOCAL HEALTH MSTRICT raS ora»REV.+/76 aM i I