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E FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .......... . ....___..-- No. ..77- 7 --....------•-- (Complete In Triplicate) Permit ........................... . .. .......... ....................................................... This Permit Expires 1 Year From base 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. 519 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... `� --- -- / R sf 2 A,� .._..- ... ...........................CENSUS TRACT ... ��--------- Owner's Name `• °' a..... r .. t--_-------• •-----.-•---•-•- ---- -• . : �-.._�: . ..._ .. -Phone .. ..--•-- - Address ........... � '...._ :..,2 L' _f ` . .. i - ° u - d city ---- rt... . ............................ Contractor's Name .._.. .._L j� f ~ ° , ' : ---- �:`_l __._. .k:f..:....License # Z.,,..��'�. ..<e? hone - Installation will serve. Residence Apartment House-0 Commercial Trailer Court 0 Motel ❑ Other -------------------------------------------- E Number of living units ...... _... Number of bedrooms ..._ Garbage Grinder ------------ Lot Size ..-.------ '!-......... �-" . Water Supply: Public System and name --------------------- -------- •-•-- -•-----•-••--- -----------------•-•--------------•-- ---....------ ------Private [ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam 21' Clay Loam M Hardpan E] 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.) NEW INSTALLATION: [ ] o septic tan or see age pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size- `, '..a'.. .`:�'..Z---------------------- Liquid Depth ....{V.............._ led e, - Capacity Al--- Type ...... Material ..... No. Compartments .-...... -----.---- Distance to nearest: Well _.__._..__ ," _ `:-,._..Foundation ----�* :-.-; _-- . Prop. Line ---__-- ' g/ � 1 LEACHING LINE [T� No. of Lines Length of each line.---- r- .......... Total Length .__ r.'. f- ------ 'D' Box __. 4 ---- Type Filter Material ..-. ---.---.Depth Filter Material ----- `1.- ------------------------- Distance to nearest: Well ._.._.. Foundation ..__/_ .w ::.._.._ Property Line .__. .....__. E IT- (y), Depth _,4 _ -- Number ------J-------•---------. Rock Filled Yes No C] Sw Water Table Depth .Rock Size .... ?C.._ ,5" Distance to nearest: Well ------ p _ Foundation Pro Line _.___� . ' ._..._... p REPAIR/ADDITION{Prev. Sanitation Permit# .............. --------•-------------- Date .............................. SepticTank (Specify Requirements) ------..._-_._-•----------------------------------•------•---••----------------•----------...._....__...._._........-•-----•---------•---- DisposalField (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 County Ordinances, State Laws, and Mules 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 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - _ x ...............• ---- _ ...._ Owner By r `� � ... ....'- ------------------- -Title _. _ r _ ?; -. .s .... ---------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ..0... ... r ----------------------•-----------------------.__-------•-----_-- DATE _: r.. _w.�'� .. BUILDINGPERMIT ISSUED ............................................................-------------------------------------..........DATE ---............................----------- ADDITIONALCOMMENTS -------------------_-- --------------------------•------•---------------------------------------------------------------..._........_..---..........--------- ---------------------- - ---- ------ ----- -------------------- ------- •---... a.P. --- ---------------------------------------------------------------•------------------------- .. .. . Final Inspection b -- '�- .. .---•--- -----------------Date -� _1.`._.��-.:......_... { p y;�,.- SAN JOAQUIN LOCAL HEALTH DISTRICT f W.