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FOR OFFICE USE:— ✓ R'OFFICE USE: . 'AP•IPLICATION FOR SANITATION PERMIT--e ------ -------- ------------------------ --------- (Complete in Triplicate) Permit N'o--------- ----- --- -- --------------- '------ ---------- ---- --------------- h Date Issued..��"�_-�-77 ---•----------- ----------------------------•------.-- This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549 and exist' g Rules and Regulations: JOB ADDRESS/LOCATION oF ... J - ENSUS TRACT---------- ------------------- Owner's ------------f-Owner's Name.-- a -;--:- _.. { .. f �- --=---------- -------------- ---Phone.-��if-.91�,� --- Address--------bg'. 9 1��- _ //[7 , . t i ---- C tv Zip p - Contractor's Name.... �.� -., , t" License Phone 4� - d_a7 ` Installation will serve: ! Residen Apartment House [j Commercial ] Trailer Court ❑ ; Motel ❑ Other�'hc_ i � c` -•'= � Number of living units: Number.of bedrooms'..`� r�_ Garbage-e-Grinde -..-:-_-Lot Size.._ i r s YyL, _Water Supply: Public System and names _. ___ r_k F -- - ---------------- Private ❑Character of soil to adepth of 3 feet: Sand (] Silt❑ Clay ❑ Peat❑ zSanri► ❑ Clay Loamyl y Hardpan ❑ Adobe Fill IVtaterialI' yf es, type- .' (Plot plan, showing size of lot, location of system in relation to.wells, buildings; etc. ust.be=placed on reverse side.) NEW INSTALLATION: (No 'septic tank or seepage pif permitted if public sewer is avaitable within 200 feet,) I r PACKAGE TREATMENT ] SEPTIC TANK ' f Size_o?'� - ... •� h S`4e" --------------- lie Liquid Dept --- Capacity_t1. o ype ---- Materiolt�rs - 4_No. Compartments _ Distance to nearest: Wefl: f 01 .. ._ -------- _- ndation r - P t Fou rop. Line... LEACHING LINE No, of Li en s 11 I .... __ Len th of ea h line �__ +b `N`"� ToLength.-.--- ' _ r, 4 --- `�' tal� ._ 6----------------------- 'D' - - -.------ 'D' Box ------- Type Filter Material --"Depth Filter Material--_..�. -- ---------------------- } rr t Distance to n/crest: Weft JK- ,----.F undatfon... f _�-- --------Property Line..: SEEPAGE PIT ` Depth.. ?. Diameter '. ...8 ----Number..__�----------------------- - Rock Filled Yes. No _ I Watr Table De th.-- --- fi" r Distance to nearest: Well--' ---------- - 1. I�Zx'� I p Rock Size== `�---------- ] - ,/ Q r f i _ -------.- =------Foundatio�n_`e ' Prop. Line-�l„� REPAIR/ADDITION (Prev. Sanitation --------------------- Date_____ _- - _ s ) Se tic Tank (Specify.RequiremeYntsY)----------------------------- ------ - --_----- ` -- -------- -�-�, ---- - --- ---t------ f ' ={ � --- Disposal Field (Specify Requirements) ---- ; ---------- E , ----------------- e __"-.....-._._. _"....... .. . .......• _ _ _____ __ -------.-_ ._...---- ------------- •------ eS ... ------------------- {Draw existing arid required addition on reverse side) ! t I hereby certify that I have•prepared this application and that the work will- be done in accordance with San Joaquin Coun q ty Ordinances,. State Laws; and Rules and Regulations of the San Joaquin Local Health District.' Home owner or licensed agents signature certifies the followin"g. "I certify that in the performance oF`.the work for which this permit is issued, -1 shall nct employ any' person in such manner as e to beco su//J{JM�\j\ o. Workman's Co ensation. laws of_ California.','.. ... Signed : ► $ 1. m- ,�•;- -Cr--- _ BYA- --- ----------------------------- --- - t ... {� r -- 4 other than owrier) h , . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYE- tv, - �-- -- -----.-------------------- -----DATE �� a DIVISION OF LAND NUMBER..- =-----=,--._.r ".-.-: DATE------- -------------- ADDITIONAL COMMENTS-------- --- ------ ------ -------------------------- ------- --- ----------=--=--------------------------------- ------------------------- ------------------------------------------------ ---------------------------------- --------- --------- -- - ------ -:- -•-_ -- - ----- - --- ----- ------ " ---------------- -------------- . `-- ......... _. Final-Inspection-by::_. - .. ��_ _." _.: ---------------Date.... {] - ---------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT res 21677 REvf7bM 3M