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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 77 Permit No. .7.sr��•`.- ........................ ........................ (Complete in Triplicate) ....._ __...._�_.._ _.- . ..._ . ;..._.... + - ..........__ Date Issues ........................... ..................... This Permit Expires 1 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. 549 and existing Rules and Regulations: j ' --- .............CENSUS TRACT .......................... JOB ADDRESS/LOCATIOlQ.�.3 �. f Owner's Name .................... c � ----Phone� ' 63 Address . .. o •SQ-N. ...................city City .... .7..: Phone ' - O 7 :....License # .... I Contractor's Name ..................... Installation will serve: Residence j]Apartment House❑ Commercial (]Traller Court 0 i. � `'s Motel ❑Other ....... ............... r11,t g .�" .......... Number'of-living units:........ Number of bedrooms .__d....Garbage Grinder ............ Lo LotSlxe .................. ............. . f _: Pe�d�Ii_)k5................•--............_..........Private ��— Water Supply: Public System and Hamer........................................................._:.-- _- _' ,? --Character,of.soll-to=a-depth of•3_feat:..Sand-[_9 ilt-0---tclay,Q �] andy_Loam Q r Clay-Loam [] --- I Hardpan t] Adobe Fill MoterI615. ...... If yes,type ............................ k (PIot 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 availoble within 20� feet,) I, �pp r I PACKAGE TREATMENT SEPTIC TANK �S ze.__-..5.- 4a....�.::.............. Liquid Depth-............_.......,...__ t { � �� t '^` Capacity rTYp� '.. Material.�d7 -:_ 1f 1 Distance"tb n arpst:''Wetl t' ...r��_� :._:--- -••• Foundation ._._1. ... L': .. Prop. Line ........... ..... j +� Length of each ine.. :". ..4�..... !Total Len th ...... .r....•••••••• O LEACHING LINE No. of lines" ,._ ............. g � g ,i � �t ff D' Box Type Filte Material: _....___....::!Depth Filter Material .'.. ., .:............... .............. .� Distance to nearest: Well -�-"�..--- Foundat16 ion ........................ Property Line .. ...T...�...-..•• Ir fib. ��'` �� .-�-� Rock Filled Yes ' No SEEPAGE PIT Depths ...... Diem ter .. ... ....... Number ...... .. ................ Z .a fr x/ ! ) . ..... ►kock Size ' Wat'er�Talile�Depth! ...----:•-- -.....----F-•�---.._. ._ ...,, •- h f V � I D� ante x rlilearest#Well ... 1 ...................:'a.�Foundation.��:�..-�---�Pr�p..rhne .: .-- ,� ._---....._.. pV J/ ' v, I ............ REPAIR/ADDITION(Prev.'.SaniationPermif )ate 1 1 Septic Tank (Specify Requirement%) ............. ---------- (1.............. ` � ' `"-------fie-s�v-.�_ �`` '' ...... _ = ...:: .._..... 4/r ..s' jy� t �'+tt�t*ylI r (Draw existing and required addition on reverse side),,,,, � f I hereby-c have prepared this application and that the work will be done,In accordance with San Joaquin County 0*inniice;;;State laws, and Rules and Regulations of the Son Joaquin.local Heallh District. Nome owner or Ilesn- sed agents signature certifies the following: I I "I certify thatpermit is issued, I shaWnofi employ an'p.personAn such manner in the performance of the work for which This l as to become subject to Workman's Compensation laws of California." j .4.0 ,} Signed . ............. ................. ............. Owner - r Title ... �.._.. .`.. ,.. ..r............... �` .•--.......... By . .... �/----- .�.... .__ . . ... . l (If othe an owner) t � FOR DEPARTMfFNT SE ONLY APPLICATION ACCEPTED 1,1Y . � _----- ..._.... .:'DATE . -3...��b,"J..,S'................ BUILDING PERMIT ISSUED / l y, �fiJY.: ADDITIONAL COMMENISO` /�...cl� .................�...... --.. . ".......:::-�. ..� ..........................•--•............ ....._..................... ......._.. 1.. ,Sr.... .... FinalInspection by: ................. t. _....._..... ............:... ......... ...................-----------..Date ......12, _ � SP;N.JOAQUIN�`tOCAL HEALTH DISTRICT .. . "4 F_u13 24 ,_,lan__ cu ,_