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FOR OFFI�CE USE: APPLICATION FOR SANITATION PERMIT - ...................................I........_ t ??(Complete in Triplicate) Permit No:_77..........5- 1i --------- -_��_____ This Permit Expires T 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 applicatio P is made in compliance with Couynty'•Ordinance No. 549 and existing Rules and Regulations: .ler) ------•---•--••---------- S ------CENSUS TRACT . JOB ADDRESS/LOCATION,.I..___ _S. _ ._..CL., Owner's Name ...............J�: `SII I T�14! 1?�s _.....................:--------------=-:------------------Phone "._i. _7.2------ AddressD.1.-Y__!0_I21w,-fJZA.c. City ---------------•---•-----------•---•-------------•---•---•---•------------- i Contractor's Name------------`'�....... ••----__1rW..AJ. ..............................= ....License # ------'."-:.......... Phone ...................... installation will serve: 4 Residence❑Apartment House❑ Commercial❑Trailer Court 0 Motel ❑Other-=..................... = - Number of living units:___}_...._. Number of bedrooms ............Garbage Grinder ............. Lot Size ____________________-----------____-____-.__ Water Supply: Public System and name ..................................•-----------•-•--------.....•-----.;---•--------.........._•---._....Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam•❑ Clay-Loam it Hardpan❑ Adobe'❑ Fill Material ............ If yes,type-----•----_---••-_._----_._ I (Plot plan, showing of lot, location of system in relation to•wells, buildings, etc. must be placed on r e side.) . %4 s ` NEW INSTALLATION: (Notank or seepage pit permitted if public sewer is available within 20 • et,) oto. PACKAGE TREATMENT ( ] SEPTIC Size____________________________________________•--- id Depth ..................... Capacity ................. Ty .................. Material----...._--.--_ ._._ No. Compartments Distance to nearest: Well ---------------- ----------------- dation ...................... Prop. Line.........-...:_....... LEACHING LINE [ ) No, of Lines ________________________ Length of e........__...:.:___._._.____ Total Length ............................ a . 'D' Box ............ Type Filter M al ....................Dep Iter Material _______..........___..____.._.._...._....._ Distance to nearest: ___ Foundation ____________________ _ Property Line ........... I SEEPAGE PIT [ I Depth _____ ------------- Diameter ................ Number ............................. Roc ed : Yes 0 No J❑ r Table Depth , ..------•I........................... ........Rock Size .........-.......... Diitance to nearest; Well .Foundation ...... Lime REPAIR/ADDITION(Prey. Sanitation Permit# .............................:-----------:.... ate ..................... --------- d Septic Tank (Specify.Regpi'rements) .......................`.........................•--•- - ....-•----....._..... . --•--........... Disposal Field (Specify-j'Requirements) .__ Q 'lLt.h�' -----------------•-•... - :- - ------- -........................................._................_._ ...... ._..._..._...... _________r_:__........... pdditilon on reverse si _^r __.__....._.._.___......___._ :_. ... ......_._-_-__-_..........__......_ _ __.__ .. l (Draw existing and required ne) 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 to the perfor1 'once of the work for which this.permit is issued, I shall not empioy)"y person in such manner as to become sub ct t W rinaru,s C pensation laws of Caljfornia." Signed.�-_�-------------•.... --- = -••---- •-'----...1..,. .:. Owner By--•-•----•--._..._....•--=-----..........................•-``..................................... __ Title• it a__.._ .y -----------...................... (If b)her than owner) FOR DEPAJITMEIV E O Y ' APPLICATION ACCEPTED �Y........ . ................ . Al DATE ....ID`°a1a'��-_--_-------•- BUI4DiNG PERMIT, ISSUED................ -= = DATE - ....._ . ADDITIONAL COMMENTS"------ -------•-•---_-..... ---••- ......... :.__. ................................a.....•_. ..........•-•---- -----------------------------------------.--.._.._ _.._..----......•--_..._....._.. ----- --:_--......---...........-......._ .-- --- �.............. :-•----•-•-------------------------------------------------.._....----- ------- Finai inspection ............. .............................................._:•--•---• -----=--- .. AN JOAQUIN LOCAL HEALTH DI .. Date .. , •7�• = I� -SICT \ C ?� F. H. 9 1-'68 Rev. 5M'