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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No 7.7•- .................•-•-•. ......... -•-----•_ ........ w ,(Complete in Triplicate). M. - . d _77 _• = p Date issue .......................................... This Permit Expires 1 Year From date Issued Application is hereby made to the San compliance liance witch alth CounttyDistrict 0 Ordinance No. 549 and exisrmit to ting Rulesinstall nd Regulations- JOB egulp ionsrein described. This application is made { p 10J..C�CENSUS ... CT ..........TRA .......... JOB ADDRESS LOCATI �- Phone Owner's Name .. � - - ----... ........... .... ............ foense .--- :�Address ��•-I�'- •• -- - -• --.........City ................................................................. Contractor's Name •- -- ---- 1 t Installation will.serve: Residence Apartment HouseQ Commercial Q'fraller Court ❑ Motel Other ..:.......................... Garbage Grinder .... Lot Size :...... --- ....... . ............. ! Number of bedrooms 9 Number of living units: -•--•--•• 13Water Supply. Public System and name _ Private PP Y: ,,. .- ---..-------••-- -.._.-_.C....__........-Peat Q.....5ondy Loom .Q....•Ctay Laam�te 3: Character of soil to a depth of 3 feet: Sand Q Slit❑ lay ❑ Hardpan❑ Adobe Fill Materlal ............If yes,type ............... ............ (plot plan, showing size of lot, location bf system In relation to wells,}buildings, etc. must be placed on reverse side.) j No septic tank'or seepage"pit permitted if publ c sewer } �ilable within 200 feet,) NEW { P L . - - -- .... Liquid. Depth .. k .PACKAGE TREATMENT I ] SEPTIC TAMC Size..- 7 - ' ........ compartments Well --- - Q .. ,r ` Y LEACHING LINE ` No. of Lines _..._. _. ---- Length- of eadi line..-------f�G.:.•.---... Total Length ^--------� v - �� - , Typo, Filter Materia! / Depth .Filter Material ..I��--�'�•........••-- ".,, i Distance t rest Well _.... `I_Q.. _ Foundations..-., �• Property Line . ... _ .._........ D' Bax .. ft SEEPAGE PIT Depth _ _... ---- Dia - �, Number ...... .-• ---•�-• Rock Filled Yes t4 No C3 '1 .; . °Rock Size Water Table Depth ...... $ ----- r/, .... Foundation ____ �_. ._. sop. Line ._l 5..... Distance to nearest: Weill _. �._ •..__.V.. . ' I _ _"• t� - Date REPAIR/ADDITION(Prev. Sanitation Permit# : -•- __...............SepticRequirements). .... Disposal Field {Specify .Requirements} •••---------• ........ --------------------- ..................... i (Draw existing and required addition on reverse side) I 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. Horne owner or licett- I sed agents signature certifies the following: arson in such manner "'I certify that in the performance of the work for which this permit Is issued, I shall not employ any p i as to become subject.to Workman's Compensation laws of California." Owner eT " Ti tie -------•------ By (If other than ownerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ' ---74��" _ DATE •-- ....-.._-7-7 ......... .......• -. ------ •'----•--- DATE --------------------------------- ----- •- AUDITIONAL COMMENTS ..------ ?----- -.-.-- = BUILDING PERMIT ISSUED ------ .F �. -- - --- - /- �� -_-------•------------ ..-----' I . - ZA81 ... r _-__Date _-- Final Inspection by' EH 13 24 1-68 iiev. 5SAN JOAQUIN LOCAL HEALTH D1STitICT 7� ��