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�. 4 r L "-IV APPLICATION FOIL SANITATION PERMIT (Lromplete in Triplicate) Permit No. .77-7.e . ............................. - 4 Date Issued This Pvrmlt Expires 1 Year From Date Issued . . 7 Application is hereby trade to the San Joaquin Local Health District for a permit to tonstrutt and Install the work herein: described. This application is made in compliance withaunt Ordlnonce No. 549 and *xIsting Rules and Regulations, 013 ADDRESS/LOCATE ; . .kip ..CENSUS TRACT Owner's Name -Z^�....` -n.... ............................ ...... ......... ....../. . ... /�j ... . ... .. ..... ..... ,.....Phone ..1�..��.`c.3'.�.C�. Address �Z.�Ya',.,�•'�3 . .L% : ....... ........ .......... CI �? d�x,. . . . . ........ Contractor's Name .......... .. ...:............................................:............License # ........................ one .............. ............... Installation will serve: Residence❑Apartment House❑ Commercial❑Ttaller Court (3 Motel❑Other................. Number of living units-,j/....... Number of bedrooms .. .....Garbage Grinder ............ Lot Size .............................................. Water Supply: Public System and name .... .. Charactei of1 ............... ................_....................................................Private ❑ soil to a depth of 3 feet: Sand Ldl Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loamjo Hardpan❑ Adobe 0 Fill Materiol ......... if yes,type ............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) �E NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer Is available within 2110 feet,) PACKAGE TREATMENT { j SEPTIC TANK j ] size.......X..�� ' ......................................... .Liquid Depth .......................... . Capacity .................... Type . .................. Material...................... No. Compartments ...................... Distance to nearests Well ...................................Foundation Prop. Line ........ LEACHING LINE ( No. of Lines . ...c�.1............. Length ofch ji Total Long pprr .......... Whl XfS71 'D'.. Sox ............ Type Filter Material .....F...�:...........Depth flit .Material ... ......... .. ............. .... Distance to nearest, Well —Zai............ Foundation a �......,.�._.. ................. R ....... Property Y Line SEEPAGE PIT Depth .................. Diameter Numbsr .......................... Rods /.�J... . ........ Filled Yes ❑ No 0 ' Water Table Depth . . .... ..........Rock Site . . Distance to nearestt Well ....................... ..........: Foundation .. . . ...Prop. Line .................. REPAIR/ADDITION(Prev. Sanitation Permit# ................................,........... Date ................................I �-- Septic tank ;Specify Requirements) ...................... .............. ..........................:..........................:....:.............._................. i pisposal Field (Specify Requirements) ...................................................................................................................... ................ .. .. ................ .... _ .j............................................................................................................... ..........................................• 3 (Draw existing and required addition on reverse side). .................................................. I hereby certify that l hays prepared this application and that the work will iso done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health DistriN.Home a met or 11c m• sed agents signature certifies the following: --- "I certify that in the erFo trace of the.,work for which this permit is issued, I san hall not employ y person in such spanner as to be a s�to i++► r I n's pen.a on laws of California.,, Signed ....................................... .................................. .............. .... Owner By ............................. (If other.........n.................. .._.......... ........ ......... . Tirle ........................................................................ � thaowned /OR DIPARTmeW usg ONLY ' APPLICATION- ACCEPTED'BY"...................................................... ................ ...................... DATE .... BUILDING PERMIT ISSUED ................. ... .. ©ATE ................... ADDITIONAL COMMENTS .............. ................................. .................................................., .................................... .................—..............:......................................................................... Final Inspection by, ..................... .. .. '•...... 10.................................. "'....................................... . ,.......}........•............. EH13 2)t x-613 Rev. ............. ........................................................&c .....L......� .."�"�................ • SAN aoAQu LOCAL HEALTH DISTRICT 6/74 3M