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ji _ta ? 7.3 =�� s�' Fog OFFICE.,USE: APPLICATION FCA SANITATION PERMIT ---------------------- ................. Permit No. .77_ �0.� �.. ...... (Complete ieTriplieate) d p _ Date Issued . ..`/1..... .. This Permit Expires 1 Year From Date Issued Oji ar-�� --3 Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the wo'A herein described.-This..appl.ication--is..madejin compliance with County Ordinance No. 549 and existing Rules and Regulations: Q � L o .... ._._.�?......._._.. .�1 ------------I...................CENSt�S TRAGI JOB ADDRESS/LOCATIO / uN� /... . . _. � .........:........... Owner's Name ._�h_Aw' .-- ................................. .... .....�d.,c?:. :.......... Address ....... City . Contractor's Name ._ . .t.... C _ '1.._ .............License # ------... ........ Phone .......................:....... Installation will'serve: Residence,®.Apartment House❑ Commercial []Trailer Court ❑ 3 �/ /�cj2 IF/ Motel ❑Other .......................... ............ t Number of living g units:..-----J.._ Number of bedrooms ...3......Garbage Grinder Lot Size .._'Z.9.... !�.................•.•_--• Water Supply: Public System and name -•----------- --•--•-- --------- -------------- .........•.................. --------------- ...:..:: —Private Character of soil to a depth of 3 feet: Sand 3 .Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material -----.--___ If yes,type ---------------------------- (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,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size.....4.4.X_9 ...................... liquid Depth --.....-----.............. N Capacity J2e."__V_41Type ...... ............. Material No. Compartments ...j9%.........:.:.. Distance to nearest. Well ...�.. 1 ....................Foundation .../.?....------.. Prop. line ...7........... LEACHING LINE [ ] No. of Lines ......3--------------- Length of each line---- .......... Total Length t.�_.9'..................3r ,j D' Box Type Filter Material IL t��'.0_...Depth Filter Material ........._�_.~...-•--...... ........:..._!i;� Distance to nearest: Well ._.�.3 -- ---.... Foundation ...7P...... Property Line -. --...-....... it t 21 SE is 1 [ I Depth . Diameter Number ............................ Rock Filled Yes [I No u Water Table Depth - •-------••-•-•-•--.........Rock Size ------•............. ---- _ Distance to nearest: Well ........................................Foundation .................... Prop. Line ................... REPAIR/ADDITION(Prev. Sanitation Permit!# ............................................ Date .............................. Septic Tank Specify Requirements) .............. ....... •.......................•-----------•-••----•.... _ .. -•----•--•------•--..._.....-------•...--•------ Disposal Field (Specify Requirements) ................. .................................•-•.................................................. ......... �� ..� __ —� _ _ '' ...............................................................------------ --------------------------------*.._... -----------------------•---------------- (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 accordante 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 k as to become subject to orkman's mpensation laws of California." } .... } . Signed . Title .................................................................. (If other thars owner) IP R DEPARTMENT USE ONLY e APPLICATION aACCEPTED BY .. ..:.. ............... DATE .? ._/. �a�/•- i BUILDING PERMIT ISSUED ........... ............................................ ...----------------..._....:: = .. D TE . i ADDITIONAL COMMENTS ...._ u��rr�l -t r°'F's_-l` " `'. ..r`'4__ ... ..' . ' r ..--------- ----------- ------------•.........---- ........................... ............... Final Inspection by. ............................................}�................ I i� ........................ ..... Final ......... . ............................... ----.... ._...... ............................................ ...//. e" r ......- SAN JOAQUIN LOCAL HEALTH DISTRICT. _ s Il 7/72 3 M