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i I R OFFICE USE: FOR OFFICE USE r APPLICATION FOR SANITATION PERMIT i Permit No.-7 �--�3 0 (Complete in Triplicate) , * Date Issued...�'.. '/:.7� v I This Permit Expires 1 Year From Date Issued D_ Ai.., zotion 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: / X43 MAV6AJ JOB ADDRESS/LOCATION / �r _ S�Hb°i CENSUS TRACT Owner's Name �Ci1CR� I�ZL- ASA Phone Address ` >..... City /�'/ �t�- zip gs'J. t Contractor's Name License #�S�735�3.Phone A6- 9607 Installation will serve: Residence ❑ Apartment House Commerciol ❑ Trailer Court [� \ Motel ❑ Other ___..- Number of living units: Number of bedrooms . Garbage Grinder lot Size ................................... N Water Supply: Public System and name ... .......... ..................._....._........ ................... .................... Private Character of'soil to a depth of 3 feet: Sand D Silt [J Clay ❑ Peat ( j Sandy Loam Clay Loam Hardpan ❑ Adobe ❑ Fill Material ._.If yes, type _ (Plot plan, showing size of lot, location of syltem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION- JNo septic tank or seepage pit permitteg ifs public }ewer is available within 200 feet,) ` X / r� PACKAGE TREATMENT � J SEPTIC TANK � Size '•� _._...._ . Liquid Depth CapacityZx Type Material �' ,No. Compartments s�► de r r I*7 Distance to nearest: Well . 1.�� ._- Foundation l D Prop. Line . . .... _ LEACHING LINE No. of Lines / l Length of each line _ lcro Total Length r _._:-_-.__-...._.. D' Box ._t/... Type Filter Material � OC>� .- Depth Filter Material.. ... r r Distance to nearest: Well Foundation 71�n_...... Property Line. SEEPAGE PIT ( J Depth Diameter Number .... ........ Rock Filled Yes [—i No ❑ Water Table Depth . .. _.............. ................ Rock Size ............. Distance to nearest: Well ._ ... _ _ f•mmdwion. ........:....:. Prop, Line ....................... REPAIR/'ADDITION JPrev. Sanitation Permit# _. .................................Date _.._._.....-..... ) Septic Tank (Specify Requirements)..,. ... ........•....................---•..._.....•......... ............................................................................ Disposal Field (Specify Requirements) _................... .............................. ......................................................................................................................-............................ ..... ; . ........................,,........ ....•..... ............... ._ ... . . .. .. . (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 San Joaquin County Ordinances, State laws, and Rules and Regulations of the Son 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 ....... .-.. Owner By I _.- Title ...... ------- Ill o er than owner) R DEP MENT USE ONLY APPLICATION ACCEPTED BY ...^�'. . ..........-- DATE A7Z3 —77............. DIVISION OF LAND NUMBER ............... - _ ...................._..... .................. DATE ......... .-......,............................ ! TIONAL COMMENTS . ... . . . .................................... i ... ..............I. ........................._..,.........._.. ................. . Final Inspection by: Ci` ,.-c. ..-....._._.. . ... ............Qoife �j. ....... ...... ... EM 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT f6,S?1677 REV.7(76 3M