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FOR OFFICE USE. APPLICATION• FOR SANITATION PERMIT .... .................................. Permit No. .7�`:!�7.z r .. (Complete in Triplicate? ......................................................... ��y This Permit Expires 1 Year From Date Issued Date Issued 5...........: 76 ..... y(vG -Z2 described This application lication is relic t oneiso the madein compliance lia ceuin cal Health with County DistrictQOrdinance permit and existing ctand Rulesinstall n.d. Regulations..herein PP p Y . JOB ADDRESS/LOCATION ..:........:_..... .7 ...:_....�u.f�G�,. �4�$_. CENSUS TRACT .........:...:....;__....: p Owner's Name .....k'_........L,:Ur.� .................................................__..._:...--------•-----..._Phone �� ..,........�. - Addressr,_.__.... r, , :?...._..__.G�!':7_. 1. ?.....�� eta .........................I City STC? / `T7 - ........................................... Contractor's Name .__..... e..Fc� ................................................License #- �'� �... Phone.;77A !.k.... I Installation will serve:-- .,M-.----Residence 'Apartment —Housee❑-Commercial ❑Trailer Court•❑-- Motel ❑Other ............................................ /4-C ' Number of living units ..... Number of bedrooms _".....Garbage Grinder ----........ Lot Size _.:. ` '..` . .............•..... Water Supply: Public System and name .............`...... ""'..... � ....................................... i ❑ � - Private Character of soil to a depth of 3 feet: Sand U] .Silt❑ Ciay'❑ Peat 0 Sandy Loam fW Clay Loam ❑ O Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ..............._------_- (Plot -----_._ -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be'placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,J y i PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size...sD ...�� !!- ................ Liquid Depth .._ ............. Capacity�_ Ty No. Comportmen#s .:�....._. ....... T e J i.7-7—Material...-- / Distance to nearest: Well ----1 .-..--.......Foundation _.........:. Prop. Line LEACHING LINE ] No. of Lines _..' ................. Length of each�line._t ------------- Total 'Length ... ............. i 'D' Box _.1......_ Type Filter Material �/„�,��.Depth Filter Material �........:.............•... . I l Distance to nearest: Well . d .--..--.-_.._ Foundation. ------:..... Property Line :,,r ....... SEEPAGE PIT ( j Depth .................... Diameter ............ Number_ ............ Rock. Filled Yes ❑ No (] Water Table Depth ...........Rock Size .......... .....•-••- •--- •- Distance to nearest: Well ...................................:....Foundation .................... Prop.. Line ................. ._-•- 4 ' REPAIR/ADDITION(Prey. Sanitation Permit .................................... Date --- ............................ I i Septic Tank (Specify Requirements) ------ ---...........I...................... .......... ..................... ................ ................................. •---•- i Disposal Field (Specify Requirements) --------------------------------------------------------- ....... ------------------.. ...........--•........... fy ------------.................------- - -...... - -r ._...--•---•.............:..------------..._...•....._....-'-------...._.........__--------•----•-------•--......... -----------•-------- Paw existi'n'g-and required ai:1 ition"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 District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Wissued, I shall not employ any person in such manner as to become subjecV6 N. ork 's Compensation laws of California." Signed Signed ------ f Owner BY ••------•................ ••-•--• ----..._._._.......------.._.._..._.:. title .......................................... ............................... (if other than owner) FORAgPARTWNT USE ONLY APPLICATION ACCEPTED' 81�f' •...._. DATE . ..: 5 ............ BUILDING--PERMIT' ISSUED............... --- :-=-•-• .......... _DATE COMMENTS .� �rnc ...GILclH� crc [raG� � • - ............................................... ........... ........................................... ---: -..-.--•--............._.•_--._--------------------•--•---..:._.:_------- ------- ................................................... :.. . ........ ......................... ............ .......---------------------------------- -----•--- -----------• ...................------------------- Final ._... ----- ---------- ....Final Inspection by: ........ :_ ...Date .- J ,JOAQUIN LOCAL HEALTH DISTRICT E. N.13 241.'68 Rev. 5M �� ___ _ _ 7/72 3-24