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-FOR OFFICE USE: 0 2-D -3 U hi P-ev PPLICATION FOR SANITATION PERMIT ................... ..................................... (� "2 � Permit No. (C77- 3ilr empleb In Triplicate( .....................•. �.. This Permit Expires I Year From Daae issued 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 3pa.Q . ....!?!:s-Pey..........Z0 4 ......� ...UCENSLIS TRACT ............. ... Owner's Nome ....../ �^fr.. .�'. c7 !/r/ ...............•-.............. ..........................................Phone ............ ...................... Address ........ 1'P ............................................ . City. !!3.r' ` .................................................. Contractor's Name ..R.141V_7- Ae jjl--- O,tll...........................License # J,!-A. ..... Phone installation will serve: Residence JZ Apartment House❑ Commercial❑Trailer Court Motel❑Other............................................ Number of living units:..../..... Number of bedrooms ---,......Garbage Grinder ............ Lot Size ................ Water Supply: Public System and name .--b4 (.-.... Q si r '/. _... f.v !...:_. 4 '.. ...............................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam M Hardpan❑ Adobe 0 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 side.) NEW INSTALLATION: Wo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TAMC{ } Size................................................ Liquid Depth ..-Yf........................ Capacity .L ....... Type RZ .4�A€fMaterial.. No. Compartments .--••.............. Distance to nearest: Well ....................................Foundation •./0�...•....... Prop. Line . .`............. LEACHING LINE ( ] No. of Lines `. .! �` Length of each line.. 9, Total Length ........ t 'D' Box ...1.... Type Filter Material k.......Depth Filter Material ... Distance to nearest: Well % ' ' . ........................ Foundation .._.. ,._.._........... Property line ........................ SEEPAGE^PIT [ ) Depth .................... Diameter Number ........-................... Rock Filled Yes ❑ No Water Table Depth ---••-..........•. ............................Rock Size ................................ J Distance to nearest: Well ........................................Foundation .................... Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit .. Dab ?< SepticTank (Specify Requirements) ....................................... ............_....................... .......................................................................,................ ......,..... Disposal Field (Specify Requirements) .........•..........................•------••-----------•--•---•............. .-••••-...---.......••-•...._.- .......-.-...-....... �y ...................-...................................................................................................................................................................................... ----•-------------------------•---•----•-----------•...--••------•••---------••---- ........................_............................................................................................ (Draw existing and required addition on reverse side) I 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 Son Joaquin Local Health District. Nemo owner or licen, sed 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 4.f/ / �` SO.Ii-------------•-.............. Owner By --..... !' ?..�: .in aide _.. .............•. --......--•••-•----••. (If othe r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . DATE .......-:l _,�7..,,...... BUILDINGPERMIT ISSUED ................---- ---------------------- -------------------•-------------- ---- --•.----DATE ----------............................... . ADDITIONALCOMMENTS ................... ...................................... ..._._........ ...._-....:................._._.:_..........._.............. ---------------------- ---------------------- ..........................._._.................................-.-.-..........-..---...... ---------........................---....... ............... ................ .... ........... --- , / ...--- Final inspection by: .. . ....... !` - EH 13 2)t 1-68 Rev 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71 3M