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.. .- -FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------••...................•---•••....---.......-...._. ICompleto In Triplicate] mit No. 77..:- d... Per --•................................. .. This Permit Expires 1 Year From Date Issued Date Issued . .T,7 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 mode I&COMPIi nce Ith County Ordinance No. 5A9 and existing Rules and Regulations, � 7 JOB ADDRESS/LOCATION ........ .........-..... ,..._... 'fie -..S..Q-._...1 .4-..-...----..._.. CENSUS TRACT ..................... . Owner's Name f�._Ri. - ...........-..-.................................................Phone --g!�.�'..1. 3.` �......---- Address ........__J- 4F3.....Pd 4P h !N py .................. City i}A/..!!7. e..._... .................... Contractor's Name -.-.��-A#07-,6_v_evy_ -1 5,v/ --License # 1d6~.52IF6... Phone �•g 3f --E/-44, •---....... Installation will serve: Residence[ Apartment Housei_] Commercial❑Trailer Court 0 iMotel 0 Other ----------------------------------- -------- Number of living units._--....-_ Number of bedrooms ..A......Garbage Grinder ............ Lot Size .-__ _�'��`. ................. Water.Supply. Public System and name --. -- -.......:!• -•--•------=----------.--------Private Ry ...,. -- Character of soil too depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam iR Clay Loom o Hardpan(] Adobe 0 Fill Material ............ If yes,type..._. -- ------------ "'A (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 ......._............ ...--- capacity /lqP----_-- Type��_<4S7Material---c¢ �'.... No. Compartments _�................... Distance to nearest: Well ------------------------------------Foundation _-----___-_---_____--- Prop. Line --------------__.-__-. LEACHING LINE { ] No. of Lines ----------------- Length of each line.-.......•----••---......... Total Length ._------_--•-----___._.._ 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ i Distance to nearest: Well ........................ Foundation -......_._..---.... .... Property Line ......................... SEEPAGE PIT [ j Depth ............... Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth.................---------_------------_---Rock Size -... ........................... Distance to nearest.Well ________________________________________Foundation .................... Prop. line __.__-____--__-_--__.. REPAIR/ADDITION(Prev. Sanitation Permit# ------ ...... ......................... Date ............................. rt Septic Tank (Specify Requirements) 1 a' �� '^ --- F ' �' �= TlklY'•_,i'�_--._. ( 60t2_........... Disposal Field (Specify Requirements) ......r�_g--••I'� f— l��r--__-_.. ....... ��'�..�-.1'#C'- ............... -------------------•..........................................-......... X�� _�_��• s ........................................... t�- ----------- --------------------------------------------- ----------------------------------------- --•- --• - (Draw existing and required addition on reverse side) 1 hereby certify that I 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 Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .... !#- a ...So-N--,-------•---------- -------- Owner 8y ---- -------- ----------------------------------- 7itie ......... ................................ --••--• -..-.._...-.....- (If other t downer.) FOR DEPARTMENT USE O YY�f , _ APPLICATION ACCEPTED BY -..---. 11�z..---.. L ~ ATE ��.�;�r--'7, ----- BUILDING PERMIT ISSUED ------------ • -----•---- -- ---------••---- ----------------------------------..............DATE _-----__------------ .......... ADDITIONAL COMMENTS -------------- ------- -- .....-•---- --_.-_.. -- .....................................................---------- .. --•----._.-------- final Inspection by: ...... . .. .. ._ Date .-- -..�.�. . c�-j ................................... y_. .............. Z3 21t 1-6f3 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 314