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a FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 77-777 ----------------------- (Complete in Triplicate) Permit ------------------- --------------------------------------------------------- Date Issued.._'7-_--J�_2.__-_7, ----------------- ---------------------.---- -----. --..- 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: JOB ADDRESS/LOCATION--------I-Yyd )'✓'• C�'�'NIV- ---- -!`l±s ------ '� CENSUS TRACT--------------------------- ----- Owner's Name-- ------TV-.7-N----- -keuv_�'�I-- --------------------------------------- --------------------- ---Phone - < Address------------- L T�---- , Yt+IY -/tr'e I�� Cit l�A-�.----- -------- ----- Y Phone_IP ------------------------- --- ----------------------------------------------------------------- - - Contractor's Name---�'',---��_�l- /�G_/_Y�.-_- SOS - License # -.--- SPG �`� 3' I .---- - --- ------ Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ _ Motel L] Other----------------------------------------- - [ ` Number of living units:___._-/--------Number of beidrooms----y-----Garbage Grir3der_�,U_ -.Lot Size.-_� .- ------- - -- 7 Water Supply: Public System and name----- - ---•-- -------- ------------------------ -------------------- --- -------•---------C------------------=---------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam L Hardpan ❑ Adobe'❑ Fill Material_. -------.-If yes, type-----------------t-------t__.-- [Plot plan, showing size of lot, location of system in relation to wells, buildings,, etc- be placed on reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size---=t-------- *- - - ----i------7---------------------Liquid Depth ------------------------- ,<Tr .<< Capacitylk---b--------TYPe � . -.---�----No. Compartments '-�--------------------- ----� Distance to nearest: Well--------- �-- -----------------Foundat'orj----- a_ --------------Prop. Line__.2b-,---------------- LEACHING LINE [ } Na, of Lines_______.---- Length of each __�`� _--___ !-Total Length._ 6d_--___________________-.-- 'D' Box__ _----Type Filter MateriaL.�Q6-��__1_Depth Filter Materia ___��-----._--_-_-------'---F---------------------------- Distance to nearest: Well------"`!��____ -- ----Foundation- +_-'ZS-_---.---__---Property Line--f �_________.----__- SEEPAGE PIT [ ] p - Rock Filled Yes ❑ No Water Table Depth meter--------------------Num--eY'---------------Rock Size------------ ----------------------------------- Distance -------------------- -- --------- Distance to nearest: Well. - Foundation -------------t- .Prop. ne REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------- ` W ------------ --- Date---------------- ------------------------------------------------ `v ------ ------- --------Septic Tank (Specify Requirementsl-------- -- --------------------•-------- - f[ �--- ��`----- Disposal Field (Specify Requirements)------------------- ----------------------------------- ----------'----------------------------- ------------------------------------ .ry ------------------E-------------------------r _ -------- ------- - - --- -- ------------ - 'r y' [Draw existin and required addition on reverse side) I hereby certify that I have prepared this application and that thework will be done ini.accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local health District. Home owner or licensed 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 . �}.v j f v s✓x------ --------e�Ci/ Owner I BY------- �� - =---------------------------- Title--------_--------=-------- --------------------------------- ---------- ot er than.owner) FOR DEPARTMENT USE ONLY X;4APPLICATION ACCEPTED BY - ---- - - -- ----=---------------------------------DATE " / —7-7—---------- DIVISIONOF LAND NUMBER------ --------4------------------------------ -----------------------------------------------DATE------------ ------------ ---------------------- ADDITIONALCOMMENTS----------•------------------------------------------------------------------------------------ ------- ------------------------------- --------------------------- ---------------•-------------------------------------------------------- ----< --------------------------------------------------------------------------------- --------------------------- ------------------: i----- -..- �1 ' - -- ----- ------------------- ---------- ----------------------- Final Inspection by / e - -------------------Date.--- ��= 6F&3 31677 REV. 7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT