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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT o 7- (Complete •............................•-- Permit No. i• I In Triplicate) . .........•-•---• ...... This Permit Expires 1 Year From Date Issued Date Issued .4 s�.77_... 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 existing Rules and Regulations: JOB ADDRESS/LOCATION /.-(. .. 79i �1' am.cn �rRAcr y ;.C<v+rner's Name ..._ ....•....................... Phone hone ................._..._...._.......-. Address ------------------ jJT�, •-•.................. ..._... • --•--•--•......._---•------•--•--....__..._.City ............................................................................ - Contractor's Name ..._.License # .............. Phone Installation will serve: Reaidenc%. (Apartment House 0 Commercial oTrailer Court 0 ` Motel [I Other----• -•--•--- ----------------------- Numbef,rof�iivin s g units:,...... __._ Number of bedrooms Garbage Grinder ........ Lot Lot Size . ••q �l Water Supply: Public System and name _.. .------•-•--------------`..............._..-----....._--......__._...-•--•----............................Private JK" Character of soil to a depth of 3 feat: Viand'[] Silt❑ Clay C3 Peat❑ Sandy Loam p Clay Loam 0 an 0 Adobe Fill Material .......... I#yes,type r ............... ............ i (Plot plan, showing sizeC0ca.1ieiii'of system in relation to wells, ,buildings, etc. must be placed on reverse side.) NEW INSTALLATION: '' lNo septic tnnk'•or�I age pit permitted if ublic sewer is available within 200 feet,) PACKAGE-TREATMENT . ,,[ ] SEPT! TANK Size... ............. Liquid Depth - � Capacity Type � al_ � No, Compartments Mater - --S +t � toy near.af;t: W I1 � ,. .. eDi5tQrC$. � Foundation � --r---• Prop. Lin N . f Lines",__ 2�EARNG LIME oo . Le Length of each Zine-.:_ Total Length _._ .7 . _.. e�1 -fox Mr Type:' ' r Materiald- S- epth filter Material __ .. ./. s: Di - oto nearestN S Foundation _...`® stan, ., ...... Line .. ....... SEEPAGE PIT r _ .,i}ept ;� iometer �� ._..---. Number .-----____ Rock Filled Yes No Q „ - 1?Va est; --� N b d l5epth -•-- Rock Size ...�G°.�: . ...� ,, ' Distance to nearest: Well !_ oundation -•- -- Prop. Llne ----....__ F � ... ' ... _ -.. REPAIR/ N1Prev. Sanitation Permit 5P --------------------------_-- -• Date ....:.................. t Septic ank (Specify Requirements) ---:` --....:.................•.................................................................................................. ..._.: Disposal Field (Specify Requirementsl ............. .. -----------•.......................... -----------•-----------------------------------------------.. ................................ -------•-- --•--• ---------- --•----------------------------------------------------•••-•--_. ;. - -•• ------ ---- -- -- - - - ---- ---- - (Draw existing and required addition on reverse side)--•------------------------------------•- --•--•• 1 hereby certify that I 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 San Joaquin Local Health•Distrlct. Hoene owner or licen- sed agents signature certifies the following: "I certify that in the performs ce of the work for which this permit is issued, 1 shall not employ any person In such manner as to becoxn/ vbl t to Signed Worm 's Com nsation laws of California." t/ I�/ ... -- . _ ---•- -- Owner BY ---------- ------------------------ ----------------------------------- ----••-•--- Title -...---- -- (if other than owner) FOR DEPARTMENT .USE ONLY APPLICATION ACCEPTED BY ---------- r.. �� _ - DATE ----------------------_- BUILDING PERMIT ISSUED __ ----- --- ------- DATE --..---------....-------..._,...-- ADDITIONAL COMMENTS .r_...:..--•--••.....---•••-_r/.2.._� .................. .. f t,�� ` r - ---- ------------------------------------ ______ __----------- ,y«_-_____..__.___..__.____-._ ---.--------------------------------------------- ---- ------ .. ...__._--____-----...._.__..._ Final Inspection b _ . . • -----�------------------- -------------------------Date��-w---....---- .... --------------•-- EH 13 2!t 1-68 14ev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71a 3M