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fOR OFFICE USE, APPLICATION FOR SANITATION PERMI :..............I..................... ........ •--- ••-- i II i Permit No. 77 � 97 # (Complete In Tdplicatel _ ............... pl figs yr This Permit Expires 1 Year From Date Issg Dafie Issued .._5_. !:_7,7.. f Application is hereby made to the San Joaquin Local Health Dis�lict for a permit to construct and install the work herein described. This application is made in compliance with County ordinance No. 549 and existing Rules and Regulations- JOB ADDRESS/LOCATION i..,....7 ;�---...._'... V.1( •�.A.....211V .......CEiVSIA TRACT ----- -- - ----- Owner's Name 1n: OU DO4fl4 �, .....Phone 4, °R0ay .. Address , c.................. .... . ........... city .............................. . -------------.-.--.-.-.----•------- --� - Contractor's Name .J. I1Ci'f -... ..I '�---'!a.`• ---=..........License d=�.�`� -5 --- Phone 04 137j! r. Installation will serve: Residence❑Apartment House'O Commercial❑Trailer Court Zj Motel ❑Other----- kj--:-.-...:................ Number of living units:_..',-�. Number of bedrooms Garbage Grinder Lot Size '-............... Water Supply: Public System and name ......1E.. ....i................Private ❑. ........................_.......................... Character of soil to a depth.of 3 feet. Sand Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay hart- ❑ I Hardpan ❑ Adobe.'w[] fill Material •-.. _.._._ I#yes,typ ............... ............ (Plot plan, showing size 1 lot, location of system In relation to wells, buildings must be placed on reverse side.[ NEW INSTALLATION: (N.. septic tank or seepage pit permitted public sewevis,available within 200 feet,} PACKAGE TREATMENT [ ]� SEPTIC TANK i Size-.. Liquid Depth ..... .__...... __. Capacity A__---- ..•.. Type �5. ,Material..Cr Jl ....:... No Co7;rop. rtments --------------- Distance to nearest: Well _ ....�.............Fo nSbtir ...( Line ..__.......�• ` LEACHING LINE , Na. of Lines ,, �---'�' rLength of each�i€ne:. .... .!Total LengthQ.._... �rr Bax............... Type FilterNI : -....-. ' _.Qepth Filter_'Aa ......................................-...... Distance to nearest: Well ---- '`.. ........... Foundation""..�_..._......._... Property Line . ......� SEEPAGE PIT Depth _.--.---___--.---- Diameter ..' --------------------- - -- Rock Filled Yes ❑ No iQ _ .Wrer able-hepth ...:.._...--•-•----•- -- �-•...... Size ... ..`.�z? --•--- � Distance to nearest: Well -------------il ""' �"' . Prop. Line ..._..--._..... - - Foundation .---.......-•----•- ....... REPAIR/ADDITION(Prev. Sanitation Permit# ......a._.....--.--�� ...........:........ pate ....... .:... ......_.. .......) O - -� - .. . Septic Tank (Specify Req luirerhf is ..-.._._. .. ._.._.•...--- .-..-•-•-i=----•-----------------••---------•--.......... .....-----•---•--•--•--_..... fDisposal Field (Specify ;Requirements( •----.... . _...---.... .--= -- ----••--------•--•-•--•--------------------------------------- .... --------------•---------------- ............. ......------............... ........ ............... .------------------ :I ( k (Draw-existing and requ _°3tJtd -.i.on- . ..-................................................ �! �- --- -- --- fired addition�kh.ieverse Side) I hereby certify that 1 have preparedlMs app callon.artl�that_the-work will be done in accordance with San 3eaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District.'Honte owner or licen- sed agents signature certifies the following: f "I certify that in the performance of the work for which this permit is issued, I shall not,-pi-y mny�ppo*rson In such manner as to become subject.to Workman's Compensation laws of California." Signed .............•- ----•1 Owner ie By.-.-... ; ---------- ----------- ....--. Jitle ---- (if other thanil owner) I j R DEPARTME T USE ONLY APPLICATION ACCEPTED BY . DATE ..�'---- ---- 7 ....-: --- •--•--- -----.....-----• BUILDING PERMIT ISSUED --- .----••- - f = DATE ADDITIONAL COMMENTS :�.-.../fs 4,1�......CY! �`"� • ...................... ------------------------- ..................... .................... - t----•----•- �i: �.7 W x 'I'..--------------------------------- 4 --------------------------------•-----.-.- {._.. -- ._.---.- ---.._.. .._ . ....... .-,-------------------------.__..--------------..----------------' final Inspection by: ------------t..... -- �(-.. ------.-Date J✓ 77-- ' EH 13 21 1.w613 13�v. �M SAN JOA IN LOCAL HEALTH DISTRICT 8/7h 3M