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-FOR OFFICE USE.- <br /> APPLLCAT[4?,N FOR SANITATION PERMIT <br /> ............................. ............... Permit No. .77-A5;�9_1 <br /> (Complot*Jn-Triplicatel- .......... <br /> ............................ This Permit Expires I Yeaf Flom-'Date Issued Date Issued <br /> L/ <br /> Application is hereby made to the Son Joaquin Local Health District for a 'permit to construct and Install the work .herein <br /> described. This application Is made in compliance with County Ordinance.No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _../.96rV 5a, loo* GA,,,9hA1 <br /> ............ .......CENSUS TRACT ........................ <br /> ................. ........................... '14 X ;.­­­­­­­-, <br /> Owner's Name ....... ....... ...... ...... ............Phone <br /> .............. ........... ...... <br /> Address "V ity .............................................. <br /> ............ C <br /> Contractor's Name ...167e----tl�&74!c!"V <br /> -- ------ -----------------------------License 0 Phone Z� ......... ....... <br /> Installation will serve- Residence 0 Apartment Houseo Commercial OT- railer Court 0 <br /> Motel 0 Other <br /> Number of living units:..--_ ----- Number of bedrooms ---A.....-Garbage Grinder ........ Lot Size <br /> .................................... <br /> Water Supply. Public System and name .............................................. ......­­....................­...................Private <br /> Character of soil to a depth of 3 feet.. SandO Silt.(] Clay .0 , Peat t] Sandy Loam 0 Clay Loam 0 <br /> I type ........... ... ............ <br /> Hardpan E] Adobe 0 Fill.M6teria[ ..... ... If yes, <br /> (Plot plan, showing size of lot, location of system in relation to wells;, buildings, etc. must be placed on reverse slde.lsll 'i <br /> NEW INSTALLATION: "I'(No septic tank or seepage pit permitted If public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT SEPTIC TANK Size................................................ Liquid Depth °:........................ <br /> F;vle ef"T Material... .... No. Compartments .. ............... <br /> Capacity .......... Type /.................... rt. A V, <br /> Distance to nearest: Well ....__4_2---__----�__.Founclation ---25�-----------. Prop. Line,..A!?�._........... <br /> LEACHING LINE No. of Lines --------*............... Length of each line__ . ........ Total Length ..............I...... <br /> V box J------- Type Filter Material AF<H... DepAhjilter Material ........... .................... <br /> Distance to nearest.- Well ........................ Foundation ........................ Property Line ...............0........ <br /> SEEPAGE PIT Depth .................... Diameter ................ Number ........................ ... Rock Filled Yes 0 No 0 <br /> Water-Table-Depth ----_---------- ...............................Rock Size ........... .................... <br /> Distance to nearest: Welt,._------•..............................Foundation ..................... Prop. Line ...................... <br /> REPAIR/ADDITION{Prev. Sanitation Permit# ........ ......................4----------_-- Date ........"...:... .:..........A <br /> SepticTank (Specify Requirements) ....... ......d:... ..................... ........................ ................................. ------................................... <br /> Disposal i osal Field (Specify Requirements) ...... .......................... ................................................... ............ ....... ........... <br /> 7 <br /> ..........--•............... ....... ---------- -------------------------._------•----•---- ------------------------*------- ---------------------------------------- <br /> 4 <br /> ---------------------------------------------------------------------------- --.--•-----------------------------------------------.----............ ---------------------------------------------4....... <br /> -required addition on reverse side) <br /> (Draw existing and <br /> 7 <br /> 1 hereby certify that I have.prepared this application and that the work will be done in accordance with Son joaqUlnt; <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in thec f <br /> pe�r!ormon e a the work for which this permit is Issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed A-%, ,4N714.4�Y P( <br /> By _'__j , _. ----- .......................................- Owner <br /> ---------­----------------­-­_­...I---­... <br /> ---------- 0!��k-e-v................ ......... <br /> ------- ...... <br /> towner) <br /> 64 c <br /> FO"EPARIMENT USE ONLY <br /> APPLICATION ACCEPTED BY _....A- �------------------------- -------------- DATE <br /> BUILDING PERMIT I ------- ...... <br /> SSUED _­__-_r1*11*------- ------­---------I------------- -----------------------------DATE <br /> ADDITIONAL COMMENTS - I—;........................... ................ ...... ...................... <br /> ----------------------------------------------------------------------------------I....................I........... ........................... .......................................... <br /> .. .......... --------------­­­­­------ ------------------ ...................... ................... <br /> ---------------------------------- -- ------ --------------------I---­------------ ------------- ................... <br /> FinalInspection by. ........ . .................. ................................................Date -----I............ <br /> EH 13 21t 1-68 t SAN JOAQUIN LOCAL HEALTH DISTRICT 3M <br />