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FOR OFFICE USE: FOR OFFIC'c USE: APPLICATION FOR SANITATION PERMIT .„ .................. (Complete in Triplicate) Permit No....�.'3. ..1i... S'-/5-79 Date Issued .... :4 ......... r ..•• • . I This Permit Expires 1 Year From Date Issued k Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 3. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: B ADDRESS/LOCATION.. S.Ts.Y.�� .. �.._.. .......JO � ... ................ .................. .......... ........ Owner's Name.... -F—AI... y.....:....... /fLF. ........ Y. .e... ........... Rhone ................ . .. Address.. . ... /X 07,�.: ..... Sl e..v�. �1,... Ci cCscyLa.v ....zip....................... & Contractors Name.. ....... ........................................................................ License Phone-..................../.S J �i is Installation will swve: ResidenceZ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.... .... s Number of living units:...... (.......Number of bedrooms...-3. ._Garbage Grinder............Lot Size.... !9cyc's • - p 'Water Supply: Public System and name.. . . ........ . Private i - . k Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam ❑ Clay Loam r Hardpan ❑ Adobe ❑ Fill Material_ .... . ..if yes, type................................ i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) Y. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( J SEPTIC TANK ( ) Size ... ......................................................Liquid Depth...............::.......... Capacity. ZOc' Type'..!. C,osl� Material..CotY�.'..........No. Comportments..x ....... .... J Distance to nearest: Well........��P.�....:. .......Foundation....��.� ...-.- . Prop. Lino .//d LEACHING LINE ( J No. of Lines . .-3.. ... .. ........ Length of each line.....fin.. ....Total Length .. .................... t . fi 'D' Box. .. .. Type Filter Material...�'�/��. ... Dep'h Filter Material...."........., ............ Distance to nearest: Well..... . ........ ... .......Foundation....... Property Line..... ........ ....... ............ i O � tiW.Number . 3 ........ ........... Rock Filled Yes ® No❑ SEEPAGE PIT (31 Depth... �.. .Diameter Water Table Depth.............:................. .. ......... ....... .. .Rock Size.....•. ........ ...... 3n. Distance to nearest: Well......�.�..................I..........Foundatio .. n..... .. .... . .. . .ProP Line.... .:. .......... ..........Dote.... ...: ...... REPAIR/ , ADDITION (Prev. Sanitation Permit#........................... . Septic Tank (Specify Requirements)...... .. ............... """"---" •w,. -. vN 4 Disposal Field (Specify REquirements) •••.•• �1 <... .. / / `. . ... S Com.+��....�?'k-o !!�C ................. ........ ......... . ................................ .... .... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County San Joaquin Local Health District, Home owner or licensed agents Ordinances, State Laws, and Rules and Regulations of the i signature certifies the following: 3 "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." /�v"lhoa v.....>S. .So.v Owner Signed... .. .. y Title..... _ . . . ....... ._... -P '1.-.. �- ... - . (If o er than owner) FOR DEPARTMENT USE ONLY 717 U DATE _� �r�.-.J .. . APPLICATION ACCEPTED BY.....�� .... �................ DATE..... .............. ... ... . DIVISION OF LAND NUMBER..._........ .... ....... ........ ADDITIONAL COMMENTS. ..._... .. . . _.. ............................... . .... at .........Dote.. . ..... . ........ ...... Final Inspection by: ... lam' •- '. ✓ "" ' ray;ian acv.z/te sts SAN JOAQUHJ LOCAL HEALTH DISTRICT EH 13 :4 4 1 �t'