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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT ............................... (Complete in Trlplltate► permit No. ..................... F Dab issued .3-f 77 This Permit Expires I Year From Date Issued Application is hereby made-to the San Joaquin Local Health.District for a permit to-consfruct and Install the work herein described. This application is ma iwr liance with County Ordinance No. 549 and existing Ruler and Regulations: .- JOB ADDRESS/LOCATION ..-... ................ ...fir`TC�/UG�...... ... ................CENSUS TRACT .......................... Owner's Name .. /f l .az�...._ ...............••........ , ...................................Phone 254' J-.`r- z........... j Address .'.............1.ZP-.0.....jV.... 4.14....................................... City . 11gsL ......_....... •..... ..._.... �`I Contractor's Name .••-•1�... .....J l ....................................License # �'�. .. Phone —13.��.•-:A��.e.K....)0 ' ' installation will serve3 Residence IZ Apartment House❑ Commercial❑Trailer Court ❑ Motel ❑.Ocher =...:...........::.................... ' � Number of Hiving units:............ Number of bedrooms ............Garbage Grinder ............ Lai Size v � ........... ......i.. ................. Water Supply: Public System and name ...................................._-....---...._......._.---•....................................-•-•---•...Private 0 r - Character of soil to a depth of 9 feet: Sand❑ Silt❑ Clay ❑ Peat 0 Sandy Loam❑ day Loom ❑ 4 Hardpan E[ Adobe(:) Fill Material ............If yes,type............... ............ ,Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse sld . NEW INSTALLATIONt (No septic tank or seepage pit permitted If public 0sewer is available within-200 feet,) f PACKAGE TREATMENT SEPTIC TANK{ ) Size.... .. . . . ................ Liquid Depth . ........... . . �.,Copaclty Ja.C'. 0..... Type Pe4.'-.<!-.SrMaterlal...................... No. Compartments k.-..... .... Distance�to nearest: Well" ...................Faundation .,lC ............. Prop. Line . r,3......... LEACHING LINE [ ] No. ofF Lines ....... Length of each ,�,,line....`7.�a.`.... Total Length 1..�0..a f.......... D. Box --'/.... Type Filter Material -11-le' /d.Depth Filter Material. . .�,��. . - , Distance to nearest: Well .1-no __. Foundation ,1 p ............. Distance Property Line y, ................ SEEPAGE PIT { Depth .. ��....... Diameter 1-242.9 . Number .......3................. Rock Filled Yes �No • t t Water Table Depth .--•............... ...:. . .... ... ..: ...Rock Size ................................ i Distance to nearest: Well ...............................�. .Foundotion .................... Prop. Line ---................ REPAIR/ADbiTION[Prov. Sanitation Permit _ - - `j Date ..................................I Septic Tank (Spedfy Requ€remeritiy ...................... ! .... ..........`........`................................................._.............._....... .... _ r ... DisoosalField (Specify Requirements) ................1.............. ......................................................................................•............ .... .--.----•.............•-•--•----•----------------•.---•-----..........._... -rte .......................... ........................._................... i (Draw existing and re4uired addition on reverse side) hereby certify that I have prepared this appiliation and that the worts will be done In anordance with San Joaquin I County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health Diddill. Home owner or Ilcen- sed agents-signature certifies the following: ' "I certify that in the performance of the work for which this permit Is issued, 1 shall not employ any person In such manner a: to become subject 1Noron's Compensation laws of California. - J S;gned .-...- � - . .t...... - ............................................ Owner F By ....... -_. Jitle ............................................................. ; (If other than owner) lop 18� CO h, FOR DEPAJITMENT USE ONLY APPLICATION ACCEPTED BY ........ '.:.Q'<..._ .............:................-----••--.. DATE I ` .................... i J BUILDINGPERMIT ISSUED .........................................e57.a..........................................................DAT E--:.-....................._................. J ADDITIONAL COMMENTS ............... ' ..................... ...........I...._...... ......-=...... .......... 1 .......................................................... ....................................... ....... ... ....... .................._ . ................. ... _.. .. .. .....................................-............................ ........_.-.. Final Inspection b .....................•-- .----•------..Date ..�!-..!.r l 1. _........... is y: ...-(G.....: ..�. . . � -e ... -.- Eli 13 2h 1-68 11ev• 5H SA OAQUIN LOCAL HEALTH DISTRICT 8/7ls 3M ; f i