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rsna airt'r[a vat: APPLICATION FOR SANITATION PERMIT '77-,27/ . ................................................. (Complateln Triplicate) Permit No. . ....................................................... �7 . " - ... This Permit Expires 1 Year Froth Data Issued - ss ed `.. Application Is hereby de to the San Joaquin local Health District for a perm the work herein described. This applica on-IIs made In compliance with County Ordinance No. SA9 an xisting Rules a tlonss JOB ADDRESSAOCATI N . .......... � ._..................rc�...._ ..... .L ..-�e cL ...CENSUS TRACT .......................... Owner's Name ..;TON ---- u ve. "......................................... ©� Phone ................................. ,_ Address /.G. 15_. ...('.f �--.C,.uQ...�4�. .. city .......t......�9................................... _._. ._._ .. . . .-.. ' Contractor's Name ..Lc� - .......................................... .._........License # ��n. �-7•. Phone 4 Installation will se Residence j&Apartment House Commercial❑Troller Court 0 eIp or. ....... ............ Number of living unit _ . Nk r rooms _ ........ rbage Grinder ............ Lot Size :--_•....... .............:................ Water Supply: -1 Public am nd awe .. ......--••......................_ _..-----•--------.._......._................---.._......._............Private 0 Character of soil to fko 3 fe • nd'❑ Silt❑ Cl ❑ Peat❑ Sandy loam ❑ Clay loam [❑ Hardpan 0 Adobe❑ Fill Material............ If yes,type............... ............ (Piot plan, showing si of 10t, location of system In tel to wells, buildings, etc, must be placed on reverse side.) NEIN INSTALLATION: No septic tank or seepages rmitted if pub Ic se ni#oblaaeiithltt 200 feet,) 6 PACKAGE TREATM J EPTIC TANK( J Size................................. .............. Liquid Depth .......................... 9 l_ _........� ...... ......................� spa ity� . .. pe - t ..........Found n ..fid.�...._.....Compartments . line . ......_..... -- -• p . _ ..�..... Materia .. � No. Cam artments ista ice to rest: Well .....1.. , f LEACHING LINE [ J o. c f Lines ...... Length of each line--- _� . Total Length f .............£ j BOX Type Filter Materia! ....Depth alter Material istar ce to nearest: Well ------------------------ Found~ art-. Property Line ....................... SEEP f 9 epth -------------------- Doallestal ......•......... Ber ----•-,-------- --------- ock Filled Yes ❑ No (39 ester Table Depth ................................................Rock Sizes ................................ istance to nearest: Well ........................................Foundation ---................. Prop. Line ., ' REPAIR/ADDITION(Prov. nit tion Permit# ............................................ Date ----------------------------------I . lb SepticTank )Specify R uirf menta) ....................._....._............. .......................---.............-....._....--•-----..,_. ..........-................... Disposal Field (Specih Requirements) - .:............... ......................................... ------ ------------.._..--•---._...........................__.._._......................._..------.....-- ••-•--•--•--- ....................................... . --•----••---•--------------------------- ------- .........................................................._......................... .................................•............................... . (Draw existing and required addition on reverse side) I hereby certify that 1 h e p pared this application and that the work will be done In accordance with San Joaquin County Ordinances, Slat Law , and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcen• sed agents signature certi es following: "I certify that In ter �he eed rr _for which this permit is issued, I shall not employ any person In such mann as to-fsaca .�uis(ect to Wark n' on laws of California." Signed .. Owner .. -•--------••--------------•-•-----•- .. Title ........... (if other than ow or) FOR DEPARTMENT- USE ONLY .1 APPLICATION ACCEPTED BY .. ...:, DATE BUILDING PERMIT ISSUED DATE ........................................... ADDITIONAL COMMENTS ............. .................•-_:..........................- .0..........................................................•...._.__........._.......__.......I................... ........................................ . .... . ...... .... __.... ..... .. .._ ................. ....................._...........__.-. .. Final Inspection by: .............................Date ...... . _ ?�- ... ........ EH 13 2h 1-68 Rov. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M