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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -� 7J ...................... Permit No. (Complete In Triplicate) ............... -a. ...... ............................... . 77 . This Permit Expires I Year From Date Issued Date Issued . ...:............. Application is hereby made to the San Joaquin Local Health District for a per 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------ - l.--G �.......�;772 j 4ENSUS TRACT ......................... Owner's Name . . ........ ... .......... .......... .............. .. Phone .. � ..._ ... .......... .. ........... Contractor's Name — # Phone _ _..� �•• � Installation will serve: Residence)k(Aportment House f-] Commercial❑Trailer Court ❑ Motel ❑Other....... t. .- .I ��' Number of living units:__ __-___ Number of edroomi.___��_Garbage Grinder ............ .LotSize _ Water Supply: Public System and �1 e ..........Private ❑. �. Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay Peat Q w Sandy Loam❑ Clay loam - ❑ Hardpan ❑ Adobe I11 Mater€aI --f i •-----.... 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,) s PACKAGE TREATMENT [ ) SEPTIC TANK I I Size_._............. ........................ Liquid Depth ....... .................. (0/,4 � Capacity -.-•---------------- Type Material--------.--.._.._.---- No. Compartments •.................... Distance to nearest: Well ----------- ...................... Prop. Line ................. LEACHING LINE [ ) No. of Lines ---------l_____.__ g g t r ____-- Length of each line'--�Q-__-.------ Total. Length .... �.....--••---- Z D' 8ox�__. T Filter Material _.� f__De Depth .Filter Material ... YPe p ...............P�.'.....••.... Distance to�riearest; Well"". _ ._ ... Foundation ....... Property line ....__.__.�.. ... SEEPAGE PIT [ l Dept ----- .33..._._. Number -___.....-/.............. Rock Filled,,�,,Yes�No __ Diameter � 0 � r Water TableDe Depth _---- . _..- �---.•---•-..; =-Rock Sixe � � ._._ ee Distance to nearest: Well .--___.t......_Found6tion. ....f.(1l ........ Prop. Line # REPAIR/ADDITION(Prev. Sanitation Permit `-.:.:....=.:.::::.'......:._-._--•------- Date --•-------- ................ k . Septic Tank (Specify Requirements) .... ---------------- �---. ......... .................-----------............ Disposal Field -_(S�ecify Requirements) .- . ....._._ ..._ s.�.- - ..'..:................ J ew-_- '7 -_.. ...._ x - . ---- - -- -- -------- i -----------------------------..... • ! � (Draw existing and required addition on reverse side)' I .hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State`Laws, and Rules and Regulations of the San Joaquin Local Health;District. Hoene owner or licen- sed agents signature certifies the Followings " """ "" "° " �;;_ =`^^ � -""� "I certify that int performance of the work for which this permit i issued, 1 shall,not employ any person In such manner as to become ct to W an's C mpens No laws*of California." 4 Signed -- ----- ----•• -• ............ r. Owner ` ............ Title _.t: .. ` " " (If oth an owner) R DEPARTMENT USE ONLY 17 APPLICATION ACCEPTED BY '. . _.._ _ .............................................. " ' DATE.-.- -7 ..... G BUILDING PERMIT ISSUED -`----. --------------------------------------•- -- ............DATE .......--------•-- -...._ � ADIJ TIONAL CO E.NTS ... _. --------------- _..--•..........................................••-----...-----------------------....-------.-..__..-..--•---_.._................----_... a r - ------ ---• -- -----•-- -••--._....-- ._.... - -- final Inspection b -------- --- - ------- -----------------Date .....�./.•-45-1,-7/7. .........__..__. EH 13 24 1-68 A JOA QUIN LOCAL HEALTH DISTRICT 8/7h 3M