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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT7-3 73 Permit No. . 77-:g...... S Komplete.In Triplicatel .� . ,_ _..._. ,.... .......... X__... Date Issued ._ fa Sf 7� This Permit Expires I Year from Dat*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 yin compliance s with County Ordinance No. 549 and existing Rules and Regulations: ' ii1 VW' ACT JOB ADDRESS/LOCATION 7................ .. Owner's Name ................ - - - �� �,1�-��'°.......city .. , Address _... . / ::.� ; 1 License # sr•,U�P one .. ......... ... ---- Contractor's Name __. _ .. ------ ....... --;-r;-.-.._ . Installation will serve: Residence .partmentsHouse 0 Commercial {]Trailer Court 1❑ Motel ❑Other`f...........................••.............. ' Garbage Grinder �5-- Lot Size ........................... �F Number of livingunits _._._. Number of bedrooms . ....:............. Water Supply: Public System and name ................................ Loa , Private , Character of soil to a depth of 3 feet: Sand❑ Silt p CI y ❑ Peat❑ Sandy Loam fl , Clay m ` 1f es a .......... Harcipan,Q Adobe Fill-Mate Ial' Yes,type ... (Plot plan, showing sire of lot, locationof.�system in relatidn "to We go buildings, etc. rrtustbe placed on reverse side.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) • € .N. I Li~uid Depth . PACKAGE TREATMENT [ ] SEPT-1C-TANK--1.,R,,. ............................................... gip _ p Size _ t _. --7 Material_.= -� No. Com artments ...................... Capacity ............. TYp� ... ----- .`.� � a ~•` ... Pro Line . Distance,to nearest: Well:_ _.--------•-•.='u-'.:..• ... Foundation P _._. length of each line- Total Length -LEACHING LINE { ] No. of Lines -----•-•... - ateria .................•---... ................ + 'D' Box ' Type Filter Material,-. ......Depth.::........... Filter M I ..: � Pr Line ........................ I Distance fo nearest; Well ............... ... Foundation ............... Property k Rock Filled Yes ❑ No 0 SEEPAGE"PIT [ ] Depth --•;I Diameter •--------- Number ---------------- ' Water Table Depth .. ..Rock Size -------------------------------- l o Foundation Prop. Line ...................... F Distance to nearest: Well ...................................... . REPAIR/ADDITION(Prev. Sanitation Permit# .....-- •- --....--•------ Date ......... .............: :.....� I - Septic Tank (Specify Requirements) ---• •... f f Disposal Field (Specify Requirements) {Spec I �-------••----......�� ---..._._. p 3 •----.._.... .................. --- ------- ..----- . . i ._... .• ----............................. ..............._.._...__........._..._....... .._--- _ H r -- --------- -'-----•---•-- -------------- t t ,.i (Draw existing and required addition on reverse side) I I hereby certify th t (have prepared this application and That the work will be done in accordance with San Joaquin County Ordinances, State Laws, rind Rules and Regulations of the San Joaquin Local Health,District. Home owner or Ilcett- sed agents-signature-siWe v�#ifies the following: ed, I shall not employ any person in such manner "I certify th"a! in e performance of the work for".which this permit is issu as to become subject to Workman's Compensation laws of California." ° ------------------- Owner Signed _.....--....kter-fha-9 ------ ), Title e ------ owner) FOR DEPARTMENT USE ONLY - - APPLICATION ACCEPTED BY _-.� - ............... .. -- •, ....•--__ ,DATE �.. BUILDING PERMIT ISSUED --- ----±-`-------------- --------•--•----- ...... ...-._DATE .-..----..--•... ----- -- ---------- --- ADDITIONAL COMMENTS --------- ------------------------------...:----- � .--•----... •........... .......... --------•---•-----••---•-•- = --- `-Date . Final Inspection b EH 13 2ti 1-6f3 itev. 5M USAN JOAQUIN zu, T. HEALTH DISTRICT s�7�i 3M k