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MAC LIPPRILZ UW1 APPLICATION FOR SANITATION PERMIT 77-2 7/ r..........:................._.................... Permit No. . . . .. . ..... ................................................... (Complete Triplicate) 7 .................... Permit.........._........................ This Pelt Expires t Year Fregt ss sd Date issued Application Is hereby a to the San Joaquin Local Health District for a perm the work herein described. This Opp on ils made In compliance with CountyOrdinanceNo. 54/9 ane xlsting Rules a tionsr JOB ADDRESS/LOCATI N .6.s2/.t`......... 9 7�... ."!`R.....17` .. .. CENSUS TRACT .......................... Owner's Name .,J.R.M. .... ........Z`/4&5,n 0�.. .. . ...Phone ............................. ..........I...._...... . .............. . Address -. .... ..3 ....... 7f.3 .......r.�r,V t...jc.�.5`�... ..._........City .... .......t...... ��?.:.. ._:.... � Contractor's Name ..lv .. _................ .._.........Lkense # `3'fQ. . Phone Installation will so Residence�Apartment House Commercial❑•frailer Court 0 el p or 'Z ----------- Q` Number of living uni . ..... ... N r rooms . ........ arbage Grinder ..... Lot Size :....------- .............:............... Water Supply: PubEic rr - --- - --------- — ..._......._.................................Private❑ Character of soil to a 3 fe nd❑ Sllt❑ CI ❑ Peat❑ Sandy Loam o Cloy Loam ❑ Hardpan❑ Adobe❑ III Mcterlol............ If yes,type............... ............ IPlot plan, showing sl of I t, location of system In rel to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION No ptic tank or seepage f� rmitted if pu is se .Mhln 200 feet) PACKAGE TREATM ] PTIC TANK j ] Size...._.............._.......... ........_ .... Liquid Depth ..........................�/ I ll ...... .` ...................... ! p p �r�-....- - Isto co to rests Wall MaterialFoundfp° n ...�No.....�. Prop. . ' LEACHING LINE ( j a. f lines Length of each Iine...7 ....... Total Length .`�.�......_....... ' Box . ... ... Type Filter Material ....................Depth ilter Material Distarce to nearest, Well ........................ Foundon .... Property L ........................ SEEPAGE PIT ( j epth ................... ................ .......... ... ock Filled Yet E3 No by toter Table Depth ..................-............................Rock Size ............................... iIslulr4 ta to nearesh Well .................__....._..._•.......Foundation ---_-.............. Prop. Une ......REPAIR/ADDITIONIProv. nit tion Permit# ..._....................................... pateSeptic Tank ISpeclfy R _.... menta) ....................................... _..............._...._...._......_...........-..................... .......... Disposal Fielo (Sped R ulrementa) ........................... .......... _........ ............ ...........-_...............................I.,....;._. F ........... ............................... .. ....... ....................._..........................................._................................................_.................................. r ..........................__....... .. ......................................... .. ................................................_.......................... ' (Draw existing and required addition on reverse side) I hereby certify that 1 boois p pared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Law , and Rules and Regulations of the San Joaquin local Health District. Meme owner or Ilcen• sed agents signalure cert{ est following: "I certify that in the serf Im est the work for which this permit Is Issued, I shall not employ any person In such manner as to-becarte—sublect to ark n' an laws of California." Signed . 1. .. Owner By ....._.. .. ... on tha . j. Title .............. . ................... n..ow er..... ...)......................................... ................................ ., pf other FOR DEPARTMENT- USE ONLY APPLICATION ACCEPTED BY .- . ............................ DATE .-. `-t. C� 7 BUILDING PERMIT ISSUED .......................... .............................................................................DATE ............................................ ADDITEONAiCOMMENTS ........................................... ._................_........................................................._............. ................. .............................. ............ .......•..........--...................... .-..........,r.... ..................................................... ............ ........................................ ......... . .... FinalInspection by, .......... ... ... .. .............................Date ...... . .... .. ........., EH 13 214 l�iR Rev. ......... SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M