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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............. Permit No. .77.�._..._..... (Complete in Triplicate) .................................................: Date Issued ............................. ....... This Permit Expires 1l 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. ................ ......CENSUS TRACT J06 ADDRESS/LOCATION��.y ..._... ........... _�.•... _.. .............: Owners Name V..- .... . • ••----•-- --------- --------------....._F_.-_..........Phone 7�--.-,.- - ..........-- r �� Address ..._.. � ...... ' : ...._.... .......... City ..>............ R [ Contractor's Name ...._`',. . ;- .. ... .. ....... .. ... ....... .............. License #A __ Installation will serve- Residence MApartment House Commercial ❑Trailer Court ❑ ( Motel ❑ Other ----------_....... Number of living unit f._.__ .... Nmbe of bedrooms .__.-...Garbage Grinder ....____.._. Lot Size '.0_ _- --.- -••-••-•--••� Water Supply: Public System and name :............. _•.- '------•---.--..._-----------_ ---.... -------------- --------------Private Character of soil4o!d depth of.;3 feet:Sander .Silt C] Clay C] Peat C) Sandy Loam ❑ Clay loam ❑ Hardpan ❑ ' Adobe-P< Fill Material ............ If yes,type .......___________________ , it (Plot pion, showing size of lot, location of. system�iin relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic itank or seepage pitpermitted if public sewer is available within 200 feet,),. rr PACKAGE TREATMENT ( ] SEPTIC TANK X S_ e... ......---••..............._ Liquid Depth .. #................. �� Material.Z__ _ No. Compartments 2 Capacity/ W_ •--....: Type =.... p ....... #.._._. Distance to nearest Well....._..._.ted__________________Foundation ..__/Q....--....._ Prop. Line`-_..!..�_......-- LEACHING LINE �Q No. of Lines ...._y______-:..: Length of\each line..___.__-6J.s............. Total Length .__�7�y._.._........_. 'D' Box ._...... --- Type Filter Material -._..Depth Filter Material ........IB............k.�................ l Distance to'nearest:. t """ �� t_��._..7�.... Pro S¢••---•......•.--• Wi311 _.._ ......___•-__-- Foundation perty Line ------- SEEPAGE PIT tp Depth ... ==• Diameter .. ....... Number ................... Rock Filled Yes No Cl:--\ • 1 Depth :_:-..-..__. _. Rock-Sizee.-MX "'.Y.�-y••--•-•- Water—Tab e p ---- ...... Distance to nearest: Well ---..:C_QV......••.................Foundation ---_ ....... Prop. tine ....: ............... REPAIR/ADDITION(Prov: Sanitation Permit# Septic Tank (Specify Requirements) --. J.t... Disposal Field (Specify Requirements) ' ....................................... .........•.............. ........................ I (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"R•e"gulations"of thg'San'J a`uin Local Health District. Horne owner or licen- sed agents signature certifies the following: II "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 ......... �....... ... ............... title ........... __. ...._.............._.._.. i (If other t owner) 4 ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B-.- .... fi.:. -�_.. _ .__.'t --:�=� .. •-----••......-•---- DATE .__. . ./.... '. BUILDING PERMIT ISSUED .-._._.._�• �.�.......................... .........•--•........... ....... DATE ----------=---------------- - .- ADDITIONALCOMMENTS ............................... .......................... ------............,....................................... .............................-.......... ...................................:....... .. .---•--. -----•-•------•---- -• 1....... �•y-••.-••---...._.._._...................................... ........ ....._ ........... ............................................ ... .. C ......... ,.---------.--.. .......... . .. ... / .......................••-_____ - »... / J Final Inspection by: __......•-_:. .. Date SAN,J.AQUI LOAL'.HEALTH .. DISTRICT 7/72314