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FOR OFFICE= USE: APPLICATION FOR SANITATION PERMIT .....__... . .__...---- Permit No. 77-�sy ................. (Complete In - Triplicatey _.....---- 77 .................I----..., : flats issued . -: .._....._ . This Pernat Expires 1 Year from Date Issued Application is hereby made to the San Joaquin Local Health District for a per'mi goaconstruct tinanRuInstall he Workansreln described, This application is made in compliance with County Ordinance No: 54 g ..... .. rl'.l. .�................... ......................CENSUS TRACT .........,............. JOB ADDRESS/LOCATION .y. ...3/• Owner's Name .../.�l'....... �......i�.l�+.'A�-�................{..._ ................_._..,.....................................Phone ... 1 Address . - ..... City .s. �.�G.14? .................................... ......... ..�_. �' ' ` �P�rt. .`7SLicensePhone .o... -Contractor's Name --- . _ - . . . ._.... installation will serve: Residence[ 'Apartment House] Commercial ❑Troller Court Motel ❑Other .....•.......... ..... .............. r �:✓/'Ci ........ .• dar a e Grinder lot Size Number of living units:.......... Number cf gbedrooms °�-. � $ ..........._ ... . • Water Supply: Public System and name -.... • .................•--......_.........................................Prlvata ❑ Character of soil to a depth of 3 feet: San&&' Sllt Q Clay Peat❑ Sandy Loam❑ Clay Loam ❑ p � Hardpan Q Adobe ill 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.see age it permitted if public sewer is available within 200 feet,) N • •� r- ` P P P P .ize_. =... Liquid. Depth ...;'y.�1.,.......... PACKAGE TREATMENT .[ ] SEPTIC TANK.) I _ ----,,.:_. ••-- 7 3; - s _ GoG1'G�'Na... . Cmparmes ...... ..........- Capacity -�X Go... Type re_Ccs` " Material CR Distance.to nearest: Well •.............FouncQion .4.t......... O Prop. Line .......... LEACHING LINE [`1. y}No. of.Lines -------l-------------- Length of each line......L®O.-�.......... Total Length .../.�D.......-...... E 'D' Box Type Filter Material AWA.G kDepth. Filter Material ....1 .................................. /.. • Distance to nearest. Well l®.---.......•• •• Foundation ./a .... "....--- Property tine ........................ .... �_.u.... Rock Filled Yes No SEEPAGE PIT [ ) , Depth - Diameter .323 Number -----•__J. 1. I' Water Table Depth .. ............................Rock Size ....y...X ...`............ r Distance-to nearest: Well '.�5R----.�..:-•----••----- ...Foundation �� ....... Prop. Line .................... • Prev'. Sanitation Permit# =-•'•- .... .....__ I.......... Date ........--=-•..:..................I REPAIR/ADI�lTIGN( ....... I.......... . Septic Tank (Specify�Re uirements) ...............................................,.........__.._..._............... Disposal Field (Specify Requirements) ___............ ------•-• ...................... -------- - ---- ..... ..... (Draw exist-ing 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 F County Ordinances,,State Laws. and. Rules and Regulations of the San Joaquin Local Health.District. Home ownar or licen. sed agents signature certifies the following: arson in such ,Hanna, !, "I certify that in the performance of site work for which this permit Is issued, l shall not edtpley any p as .to become subject.to Workman's Compensation .laws of California." Signed _-.. ------ ............................. •------ •--•----------•-••. -•- Owner o .- tip,. BY ......................... Title ..... _ .:I a r...---.... ...... f ofiher than owner) FOR D PARTMENT U, , ON -Y, 4 DATE.: APPLICATION ACCEPTED BY _.-.-----.-- - j BUILDING PERMIT" ISSUED r.. ------- ----- .--- ••... ... ..........--- . .. --DAT( ADD#TiONAL COMMENTS ._ .....-- I ..-- .. ..............._ -------------- -----• ......------• ..........' .. ------ ----- • Final Inspection by: Date ..... - . . 1... .7.... ....--- - ... - .- EH 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT