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APPLICATION FOR SANITATION PERMIT 77 13� ..............................................----•---- Permit No. .........-..•-._..- `rr (Complete In Triplicate! `/ ....... ...................................... ......... This Permit Expires 1 Year From Date Issued Date Issued ._,7.7 .7,111 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No 6219 and existing Rules and Regulations: JOB ADDRESS/L ON _.�� G..9 ',�_ S�o r� 1(iSc } tS. ............CENSUS TR/ACCT ......................... Owner's Name --11 t.t .�9. d . _ . ./s?/ h- y ds -�6S�.E'. __.. ......-....•....... _• Address . —374--y �A� - .-IQ ' .......I..... -........._...City .: o.�. . .O.'ej------ _ - ------..._._. Contractor's Name ...--�w V- •-_-------•------• .................................License # ----- --------- Phare --_-------•---•---•-•- Installation will serve: Residence M Apartment House Commercial❑Trailer Court 0 Motel ❑Other .... .............. --------- ---.. ...... - Number of living unit::_.:..!.... Number of bedrooms _2.-...Garbage Grinder _ ---- .... Lot Sin :,.;?_199L......-..--_----------- � Water Supply: Public System and name ...... _t. -....__..................... . Private ❑ Character of soil to a depth of 3 fent: Sand 1] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ Hardpan❑ Adobe 10 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....-..............:--------- ----•-----.------ Liquid Depth ........---_-----_---- Copac:ty/P_Qf7-f'(.&ype ----------- Moteriol.001k.zte&No. Compartments --- Distance to nearest: Well .-Z�. ...............Foundation .../b....-------- Prop. Line .. .. .--.. LEACHING LINE [ ] No. of Lines ... ............. Length of each �line.� ,2 .-....... JJ � ..- ....... Total Length .�.�........_. 'D' Box .....`.---- Type Filter Material Filteterlal .......1�.............. Distance to nearest: Well .1�/r(,1.......... Foundation -Zdt................ Property Line ............ SEEPAGE PIT [ ] Depth .................... Diameter .............--- Number ............................ Rock Filled Yes ❑ No Q WaterTable Depth .............. .............. ....... ..........Rock Size ...... .......----------........ Distance to nearest: Well ........................_..............Foundation .................... Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# ................... ........................ Date .................................. SepticTank (Specify Requirements) ........................... ................................................ .... .................................................... Disposal Field (Specify Requirements) ............. ---- ----- ----------------- -------------------- -------------- - ----------- ......... ...................................... ....................... --...... ............................. - ------------------------------------------------ ..... ....... (Draw existing and required addition on reverse side) 1 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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance oft work for which this permit is issued, I shall not employ any person in such manner as to beco a ubj t to W 11k,��m''an's mens :on laws of California." Signe � .--...- '.V. .. ............. .---------- Owner _ r . By ------------------------------------------------ . - --- Title ... - __ _ _ ----- - ....__.. (If other than owner) FO P T ENT USE ONLY APPLICATION ACCEPTED BY .. - - -... - - ... - DATE - ...._- 77 BUILDING PERMIT ISSUED . _...--- _..............DATE _. _----- ..-.. ADDITIONAL COMMENTS . _ rcK —._- - ---- v-n.K..s{. .�... jc.�Z� ----------- ...................... --- ------- - ----------------- ---- _ --------------- --------•------------ ------- ................................... ..................................... - - _. --- C .. -- -------------------- _ .. _.. Final Inspection by: - .. - ....- +� .� - ✓�j: �/�E1�2// Date. �:.: ...... EH 13 2ta 1-68USAN JOAQUIN LOCAL HEALTH DISTRICT 8/7W 31'1