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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 77, ----------------------------------- (Complete in Triplicate) Permit o----------------------- ---------------------------------------------------- ---- Date Issued.l->-.---:�_7 72 This Permit Expires 1 Year From 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: �� JOB ADDRESS/LOCATION. ?"'. _'fc .._ O�Ff .E_ -.- /✓ -------Lor- ......... . ---CENSUS TRACT----------.------Q�✓. Owner's Name 1 � ��:nil�% C°'�2,5'r Phone-- ,S^�"6Ur �'� Address' p. Contractor's Name------- 12E.S_!�__ p ,S / ------License #��JX&91-�-----Phone_��__`��--�Q,� Installa'iCK will serve: _.Residence Apartment H6use.D] gommercial ❑ Trailer Court ❑ t Motel ❑ Other------------------------------- ------------- - _ Numbe'of living units:_--_-I----------Number of bedrooms-.--Garbage Grinder-_____ ___-_Lot Size--___ F Supply: Public System and name-------------3.,4_ -------------------------- ------------------( ----- - ------------- Water --------------Private El Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ ' Clay ❑ Peat ❑ Sandy Loam ❑ Cla Loam 9 Hardpan ❑ {AdobeA Fill Material-- _-`--_.__If yes,-type-------------------- i (Plot plan, showiog.,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 publics wer is available within 200 feet,) Of PACKAGE TREATMENT �� . C ) SEPTIC TANK Size -- - - ---------------------- ----------- Liquid Depth - Capacity_�� ____- y'Qe_[�ttC.�tMpterial�fKf �_..___No. Compartments-__-4�-_____-_ -------------- f Distance tc�aeareJ�.stL Wel� _ ___ ______ ___________________Foundation-./K_._____.__.____.Prop. Line-�v_0_---__-____ LEACHING L1NE l Na. of Lin s__-��iiJJ_____ .�____. �Length of.ea line..-_--Q_-1__-----_----- Total Length ___________�_-____________________ t "' 'D' Box-_,__,Type Filter Materia Depth rilter Material.-_____._ _ x„-------------------------- j Distance to nearest: Well-- - ------- ---- ------- oundat1on__A:57._.__--_-.---Property Line------- _-------_-----__-- SEEPAGE Pa: Depth__ZS”__Diameter_-_Q- -----Number------ -_ _---_--------------- t; Rock Filled YesX No f N // Water Table Depth Rock Size ----' + Distance to nearest: Well. _ ____ Foundation___/-------------------Prop. Line- �---- ---------- t € REPAIR/ADDITION,(Prev. Sanitation Permit#---------------------------------------------------Date_-.-_--.--_--.--------._----.---___.____...__ ) Septic Tank`(Specify Requirements) t'' {" ---------------------------------------- ------- ---------- -_----- Disposal Field (Specify Requirements)------------ ------- -------------------------- ------------------------------------------------------------------------------------------------- E ' , 1 i ----------------------------- ------------- --- --------------------------- l-------------•-------------------------------------------------- ----------------------------- "'-------------= ---- ---.._ . t ` (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 wi1#i San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed 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 becom subject rkman's Comp sation laws of California." Signed,V5 .___" 'ejW4,V- 1 /1�c =-'�----i*mCr- F # : t By---------------------------------------------------------- - ---- - � Title --:---- �..� .� _(if,other than owner) D'E AIRTMENT USE'ONLY APPLICATION ACCEPTED BY . ----DATE f __ 7 _77 - ----- ---------- ---- OF LAND NUMBER..- ----- --- -$'= --7-3 DATE ADDITIONAL COMMENTS-------------------- ---- ------------------- -- - ------- ------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ---- ------- ----------- --------- -- --- --- FinalInspection by ---- ----- -- ------------------------ ---------------------- ----- -----------Date ------------ ---------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7176 3M