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s FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT .. .............................................. ICompfete in Triplicate) Permit No. ZV-03'.` Date Issued .6__2s�- 77 ...............:............................ This Permit Expires t Year From Date issued .. Application is hereby made'to the San Joaquin Local Health District for a permit to construct and Install the work heroin F described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulotlonst 2 2 -...... � JOB ADDRESS/LOCATION ...,.. .. ...............................CENSUS TRACT ..................... Owner's Name ....T` i�/._. ._.... ._....................... .................................... Address ............IS�J-...1._7 •.... . r�s ....... ............ . Phone ....__... ...... j Contractor's Nome-'. ...License #2.2$'.�S"�1..�a._. Phorw -63a1lT��Q �.G7ilJ....._ ..-.. . . ....-.._..._. Installation will serve: Residence❑Apartment House 0 Commercial 0frailor Court 0 s � Motel 0 Other ...................:................... Numbof living units:......._ ,, Number of bedrooms ............Garbage Grinder ......._.� Lot Size ............................................ Water Supply: Public System and name ......................._................................_..................---..............................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ ClayJ Peat❑ Sandy Loom ❑ Clay loam moi' i Hardpan O Adobe ❑ Fill Mcteria) ......-..--. 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 j ] Size..419.9'w.............................. Liquid Depth ..........................� Capacity, Type t Material..�.st-- !•� o. Compartments Distance to nearest: Well „7 Ph&....•..................Foundation _.!s .........Prop. Line Za..,-� ........... l �Y LEACHING LINE [Or No, of Lines �^�-... __... Length of eacho-.`............. Total Length Xe . .............. 'D' Box .O-N-4_. Type Filter Material f ,�.,=�}..Depth Filter Material _ .`'p. .........ch..... ....... � Distance to nearest: Well v�>��.:_+R:.._._.... Foundations.®.� � Property Line ................... SEEPAGE PIT Depth !rte'" .,.__..__ Diameter Number ...i?+'} ............. Rock Filled Yes 0— No ❑ Water Table Depth rM- .................................Rock Size ../.*...................... ` Distance to nearest: Weli�.�m..............................Foundation .7Q..L........ Prop: Cine � REPAIR ADDITION IProv. Sanitation Permit ----.............. ....................... Date ..................................11 F Septic Tank (Specify Requirements) ....... ................................ ...................................................... _ .._................._.............. i Disposal Field (Specify Requirements) ............................................................................................................................... .... ---•----•---•--•--•--•---._.....--••--.._._..----------•-•-•.................----• ......................... .................................. ............................. (Draw existing and required-addition on reverse side) I hereby certify that 1 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 HeaHh District. Hassle owner or iiata- sed agents signature certifies the following: "i certify shot In the performance of the work for which this permit is issued, I shall not empley,ony person in such manner as to become sub'ect to 's.Com en laws of California." � Signed --- ... .. Owner 3 _,F ..... By.... ! oNier than ownert ......•........................... Title ....... ............................ lif FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... .... .... .. ..... _. . .. DATE ...... �,j-.d.:.. ... BUILDING PERMIT ISSUED . _.....'..-,..-....• .: ........... ..... ....:...................... ....__...--•---... ............. .......DATE ................._..........._......... _. ADDITIONALCOMMENTS....................................................................................... . ........................................_..._........_........_... ................................................................ ........................ ............- -.-.._ - - .....-•-•••------....--•....._................-----••----.......... .........................--- -.......... . ... z -- Final Inspedlon by, .. ... .---.•-_. ......Date ......... ....... i SAN JOAQUIN LOCAL EALTH DISTRICT t� .E. H.13 24 1-'68 Rev. 5M __. . - 7/72 3 M