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:ro FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 75.:77 -• ..._....: 4. w ,lCarnpletsin.Triplicate) w ...........................+.......... _,. Date fssued .------ yv : _... �...............:......•..... This Permit fxP fires i Year From bale issued all the work Application is hereby made to the•San JoaquinLocalwiHhalth nytOrdinance rict rpermit and exlisting Rules tand Regulations.. t' described. This application is made in compliance - �-�.:......CENSUS TRACT ........................... . - �` ._.L..... -_ - :•:•�1r��` JQB ADDRESS/LCCATION E Phone .. . T - .._.._.Owner's..Name� , itY.. .. C - nr Address- --------•-••-- - � � -------•----••......-..............License � a ........ Phone -----^ -- ` Contractor's Name — Installation will serve: Residence p Apartment House fl.Commercial oraller Court i ,t•, i _ ' 'Motel []Other .... - L ' Number of bedrooms ---Z--•.•.Garbage;Grinder Lot S1 a ... _ Number of living units:--.�__-.... i Private Water supply: Public System andname _._.---'•--• ••---•-••-••• PP Y= -- Clay � - � � Loam r peat Q Sandy �] la Character of soli to a m El depth of 3 feet: Sand Silt❑_�-Clay_0- t Fill Material ...._... ...If yes,type ..... ------ � HardpanA{] Adobe Q e............... (Plot plan, showing size of lot, location of}system In Halation 'to wells, buildir►gs, etc. must be plated an reverse side.) it ermi d public sewer is available within 200 feet] NEW INSTALLATION- (No septic tank or seeps p p -_" Liquid Depth ........•--•--••:..._ v SEPTIC TANK ze.._...------••............ PACKAGE TREATMENT { ] . f �— I j Ype Materla No. Compartments •-- Capacity _ .. ---•• t ..Foundation �•....---..-•---- Prop. Line � i Distance..to nearest: Well �---- - '................. / 'r? __.: Length of each fine._:_ Total Length LEACHING LINE { No. of lines ..?�_.... ..... ..•_.. --•-- --- ..._ D' Boxe,.._.. Type :Alfer Moterial l •Depth Filter Material - ': .. - Property Line t T F� ;;< 4 -- ---rDistance7to +'earest: Weil `/;�- Faundatior3- SEEPAGE PIT ( ! Depth Diameter ':---•------••--- Number .......................... Rock Filled Yes 0 No Q f 4� + -�-- ..Rock Size ........ . Water Table Depth ............. '-•••---- ' ' Foundation op. Line ........._.. i e ..•i Distance to nearest: Well ._.__.. ....•-•-.--••-•---••• $ 1 Prev. Sanitation Permit# ....... Date REPAIR/ADDITIONI ••----------•---------------- .... ............... I Septic Tank (Specify Requirements •--- -..... ........ • ( P fY 1 ................... Disposal Field (Specify Requirements) ---------------------------------------------........................................... ..----..---- ------------- •------• ---- -----•--------------- - ...._............._. ------------- ---------------- ------- ------------------------- ---------- ---•-••---....----••---•---•------ (Draw existing and required addition on reverse side) 1 hereby certify that 1 have.prepared this app licatlon and that the work will be done in accordance with San Joaquin County Ordinances, Slate Laws, and Rules a.nd Regulations of the San Joaquin Locat Heallh.Dlstrict. Home owner or licen- sed agents signature certifies the following: ny person in such manner "I certify that in the performance of the work for which this permit is issued, i shall not wnploy a as to become su_b' to4WIkurnan,' ation is s of California." Owner Signed . • --- • - I 3itle --- ... .......... . (if other than owner) FOR DEPARTMET :ELSE ONLY 7�- ..... ........ DATE ..... .`Z--.... - APPLICATION ACCEPTED .BY -- -- DATE - ... BUILDING PERMIT ISSUED —i1---•----•-------- ADDITIONAL COMMENTS --- 1 ------•.......................................•--------•-----------------•--:......._.._..----•----------- --------- --•--•-•--------- ..... ..................---- --------------- --- ..--..----- •• ........-. --------•--- --------•---------- -----•-- Date ...... ...—J1 76 Final Inspection by: -------- -- --- B/74 3M EH 13 24 1-613 lfe�v. 514 SAN JOAQUIN LOCAL HEALTH DISTRICT i