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FOR OFFICE USE: 10ar APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) ---------------------r--V I------------ --------- 1_� I Date Issued ------------�)- ------------------------------------- This Permit Expires I Your From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein.k described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION 77--- ------ CENSUS TRACT -------------------------- Owner's Name ------- -- - - ----------------- -------- ------------ ------r-------Phone ------------------------------------ Address ------- --------------_----- city _,T_rXgW -------------------------------------------------- Contractor's Name ---I-Irr-17- ----------------------------------License #/40�1,,.ZL7Z Phone �_W- 747�-.ZAIIO Installation will serve: Residence $Apartment House,E] Commercial ElTrailer Court ;,E] Motel F1 Other ------------------------------------------- Number of living units: 112--- Number of bedrooms --- ...Garbage Grinder Lot Size 044V- e--- -- ------ - . - .......... Water Supply: Public System and name ---------------------- ----------------------------------------- ...............Private ................................. Character of soil to a depth of 3 feet: Sand'E] Silt F] Clay M Peat E] Sandy Loam ❑ Clay Loam I-] Hardpan E] Adobe E] Fill 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size__-_________________________________-_--- --_ Liquid Depth ----------- -------------- Capacity -------------------- Type -------------------- Material---------------------- 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 -------------------- ....................... Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ----_-------_- ------ SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes C:] No (3 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest; Well ________________________________________Foundation -------------------- Prop. Line ............... ------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ---------------- -- -------------- - r�- -------------- Disposal Field (Specify Requirements) ___? ------------------------------------------------------------------------------------------ -x i's)A-,-YIf---------57" ;-- --------;r- ------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 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, I shall not employ any person in such mariner as to become subject to Workman's Compensation laws of California." Signed ------------------------ ---- ----------------------------- - --- ---------------------------- Owner By ------ --------------------------- -------- - ---------------------------- Title --------Arv_Aipl I------------------------------- (if oth an owner) FORI-0EPARTMENT USE ONLY APPLICATION ACCEPTED BY ------N----- -------------------------------------------------------------- DATE --.97((0=_!�-- ------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------- --------------------------DATE --------------------------- -------------- ADDITIONALCOMMENTS -------- ---------------------------------------------------------------------------------------------------------------- -------------------- ---------------- -------------------------------- - -------------------------------------------------------------------------------------------------------------------------------------------7------------ --------------------------------- --- ----------------------------------------------------------------------------------------------------------------------------------------- ----------------------- ------------------------------------ - -------------- - -------------------------------------------------------------------------------------------- ----------7,;--n — i�- --------- - FinalInspection b - - ------------------------------------------------ ----------------------------------- -----.Date ------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M