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o FOR OFF.I�CE USE: - -" APPLICATION FOR SANITATION PERMIT f 5 ---- � Permit No. _77'___�_ (Complete in Triplicate) -___- This Permit Expires i Year From Date Issued 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 applicationis made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �! 52 m JOB ADDRESS/LOCATION �-- -�-- - ---------- --al.0----ox,----------P �{---------------------------------CENSUS TRACT -----55-------------- Owner's Name ---------------- .'-PrY-TilU--- 1 SS1 2 2:-----------------------------------------------------------Phone ------ Address ---------------- .9-'r C11,L'f__fJ_I2Jti, 11�AS�-----------------------. City - ---------------------- -------•------------------------------------------- Contractor's Name ------------------- ---------Oi-A1-I�------------------------- -License # ------ ------ Phone ----'----------------------- Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court ',❑ Motel ❑ Other ------------------------=-------------------- Number of living units:--- ------- Number of bedrooms ____________Garbage Grinder ------------- Lot Size --------------------------------------------- Character of soil to a de th and name ---------------------------------•---------------------------------------,----------------------------------- Private E]Water Supply: Public System p of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 1:1 Clay Loom=01*' Hardpan ❑ Adobe'❑ Fill Material _ if yes,type ---------------------------- (Plot plan, showing of lot, location of system in relation to wells, buildings, etc. must be placed on re a side.) 44 NEW INSTALLATION: (No s tank or seepage pit permitted if public sewer is available within 20 . et,) 40 1, oE. PACKAGE TREATMENT [ ] SEPTIC TA Size------------------------------------------------ id Depth -------------------- d I -------------------- TY ------------------ Material--------------- ---- No. Compartments -------- ....... Distance to nearest: Well ---------------- ----------------- ndation ---------------------- Prop. Line ---------- LEACHING LINE [ ] No. of Lines ------------------------ Length of e----------------------------- Total length -----------,----------____-• ial --------------------Dep 'Iter Material --------------------=------------------- --- ' D' Box .____.____._ TYpe FilterM' i Distance to nearest: ------------------ Foundation .--------.------- - Property. Line ---------.__--__ ----- SEEPAGE PIT [ ] Depth ----- -"----------_ Diameter ---------------- Number ------------------ Roc ed : Yes ❑ No 0 Table Depth :----------i------------------------------------Rock Size Distance to nearest: Well ----------------------------------------Foundation -_------=------_-L::7Prop:U1 -__- --- REPAIR/ADDITION.(Prev. Sanitation Permit# -----------------------------------------=-- Date -------------------------'---------] Septic Tank (Specify.Requi-rements) ---------------- --------------------------------------------------------- -------------------------- Disposal •---- ` �2c'�ChL1 Disposal Field (Specify",,Requirements) -------------- 2 _ -------------------------•-- ---•----------- " --------- ------------------ - -- ---------------- -: is Y (Draw existing and required oddii; n 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., "1-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 become9,psu�b pct tr/W n laws of California." Signed. v Oman's C ensati.o f Owner 7 -------------------------------------- ------ - p - -------------- - ------ $Y =------ --- ------------ Title ---------------- --------------------- ----------- -- ------ -------------- (If biher than owner) FOR DEPA TME E 014LY APPLICATION ACCEPTED BY -------------------- ------- DATE __..1�(J- d"�r____ ___________ BUILDING PERMIT ISSUED'------------- ---- ---------= ---- --DATE ------------------------------ --------- ADDITIONALCOMMENTS;'--------------------------- -- ---- -------------=--------r__ ----------------------------------------------------------------•----------- ----- -- ------------------ ----- ` ---------- ----------- --- ----- -------------- --------------------_---------------- ----- ---------------------------------.--.- ------------------------ ---------------------=--------------------- -------------=------------------------------------------------------- ----------- ----- ---------- Final Inspection b �� ------ ---- -- -------- Date -__/p7- - p Y- -----------i, 8i--. JOAQUIN LOCAL HEALTH DI ICT C E. H. 9 1-'68 Rev. 5M"