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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _..................... . Permit No. .77 ...... s ICompleto in Triplicate) ..................................................... ....... This Permit Expires 1 Year From Dat*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: OB ADDRiS5/LOCATION ..... ..ff �.:.. 2Q � �r.:.............................CENSUS TRACT a`Q- rc�2�-=.7 Owner's Name ....0040 Iy---.-.O. ._!07XI_f,�'�.�.Jai'z.L��..��/!4/.........................:................fhone .......................I——....... Address • - /. _Q.._---• ......... ..............:.... City .............__......... .... Contractor's Name _ 1� •-z _ _ ::.............License # . ?' /..7 - Phone ....�7� ?.5sw tnstollation will serve: Residence 0 Apartment House 0 Comm rciol OTraller Court 0 Motel ❑Other....e6z. l-- Number of living units:...--.------ Number of bedrooms -------.----Garbage Grinder ............ Lot Size Water Supply: Public System and name ..............................................................................................................Private Character of soil to a depth of 3 feet: Sand Silt[] Clay ❑ Peat❑ Sandy Loam 0 Clay loam ❑ Hardpan❑ Adobe 0 Fill Material ............ If yes,type ............... ............ (Plot plan, showing size of Jot, location of system In relation to wells, buildings, etc. must be placed on reverse slde.1 1 NEW INSTALLATION: (No septic tank or seepage pit .permitted if public sewer is available within 200 feet,) s � Q PACKAGE TREATMENT TI Depth Capacity t>2.00P---]- Type Ma#erl.�_-- -s-�c 7 No. Liquid Compartments ..Z.............. . -Distance-to nearest: Well ------/Q-0-------...............Foundation _le?............ Prop. Line ....1:�............. LEACHING LINE [ ] No. of Lines 5 _1-- "Length of each line.....A Total Length �......... 'D Box'e�n_ _ . ype Filter Material':/�i,�l._�___.[)epth Filter Material ... .............. .................. Distartce to near! t: Well ... G Q-... ..... Foundation /0. ....__...... Property Line ..�.................i SEEPAGE� PIT I 1 ` Depth. -.-•--•----------_ Dioi�neter - - _._..___.- :._....,�Rock Filled Yea ❑ No i❑" t Water Table Depth ...............................................'.Rock Size ........_...._.....:........._._ Distance to nearest: Well ........................................Foundation .................... Prop. line ...................... w_. REPAIR/ADDITION IPr®v. Sanitation Permit# .........__.-- -------------------- Date....................._.._.......... ) Septic Tank (Specify Requirements). ........ .................... Disposal Field (Specify Requirerinents) ------ ----------------------------------------------------------_.......... . r .. .. ..... ..•--..I...................... ----------------------------- --------------------------------•---•-•------------...----•--•--•----•---•..............•-----------..............................--..................... .. .. {Draw existing and required addition on reverse side) I hereby certify that # 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 is issued, 1 shalt not employ any person in such manner as to becomespblect to Workman's Compensation laws of California.,' Signed ------ -- :-•-•----------------- ----- Owner By - -------------- Title ! *G_ z.c��P-A� �_jifoiher an wner) . FOR DEPARTMENT USE ANLY, APPLICATION ACCEPTED BY __-------------------------------- ..... J�� DATE .... -, .. = ....... BUILf�ING PERMIT ISSUED . -------- --•------ ................DATE _....._.. ........ ADbfTI�fVAL O MENTS '"z9 7------ � � - ._�:.«aC�_..�-".G'X: �j��.x�w�'�'. 2.1 'If _............. ------------- --------------------------------._-..-............._.....---------- ..........------.........�_-..._............ •----- ----_-•• ---- final Inspection b ,l �- - /. -=77.................... p y. -•--------------•----•--........._...._.--•---•--------•---------.--------••-...._........`_. _..._ .. ..Da#e ...... .- EH 13 2� 1�8 t��• 5 SAN JOAQUIN LOCAL HEALTH dl RIC€' 8/7[l 3M co