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FOR OFFICE USE. . APPLICATION POR SANITATION PERMIT ...... Permit." Permit No. (Complete in Triplicate) .......................I.............. ._. Date Issued .......:._.: _...................................... [ This Permit Expires } Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 559 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...1k 77T_ ."..re. CENSUS TRACT .:Owner's Name ...... ....-- - ..................... —............ ......._..�... Phone.87k7. .7.q ........ , . Address ............................. '..17 ...1.y........._ -•------ City t - 're"`...--------..__...:........ �or-w� ZSR'-3 3 Phone V�6.79 - Contractor's Name ................ . -•-- e # ..... . _ ._.._..Licens Installation will serve: _ _ _ Residence (Apartment House Commercial j)Traller Court C] Motel ❑Other.:....'...................................... Number of living units.----- -_.._ Number of bedrooms .....3....Garbage Grinder ............ Lot Size .......1©.. __••-• i ,Water Supply: Public System and name ..........................•--...............................................................•...._.............Private Character of soil to a depth of 3 feet:f Sand U Slit❑ Clay d Peat❑ Sandy Loam ❑ Clay Loam Hardpan .Adobe-❑,, Fill Material ............ If yes.type ....-_-----------_- (Plot _..............(Plot pion, showing_ size,of lot, location of.rsystem 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,) If I PACKAGE TREATMENT ( ] SEPTIC TANK� �"" e:...-__S.......<..................... Liquid Depth ....�.....-........ . . Material �8'Y�'�' No Compartments Capacity .�� .-• ---- TTP@' ••--- -••- ------- -- --------- - � p � ....._._.............. - Distance to nearest: Weil ....:.-.-., ..a:......•-••.foundation ..__-_...'0 _ . Prop. Line ..-�7...,t ......... , IN .e�-' ..._....: Total`Length ../7Q..'� LEACHING LINE � No. of Lines .-----��.._�.::_:` Length of each line........ -- --- f� •----•.-�. � - � - 'D'-Box• "��•Type-Filter-Material ... ...Depth Filter Material- _....:R........................ --• OQ Distance to nearest: Well ...: Q.••f .••- Foundation ....... 0_."r..... Property Line .., .. ........- � t SEEPAGE PIT � Depth ...��..._...._ Diameter __ �� -•-•-.-. Rock Filled Yes � No Q j ' 3.1..:.:: Number ---------------•--I i Water Table Depth -----•--•--....---•--•-.-� .... .....6..... --..Rock Size Distance to nearest: Well ...../.M...........................Foundation _.dl�r.t ...... Prop. Line _.5 ...... , REPAIR/ADDITION(Prey. Sanitation Permit# ......................4.....__..___•.--•-... Date ..................................) Septic Tank (Specify Requirements) ...................-...............__...................... ......................:....................................._ ..-------- Disposal Field (Specify Requirements) ------------------ ---•--- -------------........................................................................ tA ------------------ ........................ --_. ..---......--------...._._......,..•---...........----•••..._........_..--------•--..........---------•--.......... ......................- s ---------------------------- -----------------• ._.. --------------••-•--------------------_.......................................... ................................................. (Draw existing and required addition on reverse side) 1 hereby certify that l 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ....".-• -- ------- - .......... . :... ......... ....................----•-•.... Owner By ............... ........... •`•.. _ . . -•---•..._.... .....---_--. Title ................._. .._!..........-- j (If other n owner) ' RTMENT USE ONLY .....................•:.__.._._.__.I.------.....--_. DATE ----,CQ:......75:73...--- APPLICATION ACCEPTED BY ...... . . ........ .. ; BUILDING PERMIT ISSUED DATE ................. ADDITIONAL COMMENTS .. ` ........................... ..................... .... ....�f`-r_,/-•---...... r S ....... ........................ .-...------- ........... .._-------•--------*...• ---•-•................ .. �E ------------------------I.......--------- -- --'--- --••-.� .. ...•.. . ........ ....... Final Inspection by: - •• •---- _ ,. _ .........I.............. ... Date.. 0• I ... // JO +QUIN :LOCAL HEALTH DISTRICT ..� _ .K_ , �..�. 7172 3-M e u 13 241_,An v- - _ j