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i4 ,O OFFICE USE: APPLICATION IFORJANITATION PERMIT Permit No: ---- 7'1- �� 1 - .. �= `° (Complete in Triplicate) — i --------- ------------------ ---------------------- Date Issued .._Sf��7� - --------------------------------------------------------- This Permit Expires 1 Year From Date Issued , : Application is hereby made to the San Joaquin Local Health District for a permit to construct andfinstall�,theIwork herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules=-and`Regulations.. JOB ADDRESS/LOCATION . ------- ------------- - -------CENSUS TRACT ---- -------------------- Owner's Name ___._ -- ' Phone -----E- ._ ----------�-- - Address --------- �W�s--/---- --- . City - - - ------- --- Contractor's Name__,.,..:_. .__-_---- License # _/Q _. 11----- Phone - l+`� Q-7---- - .,.+.______._-____-.--`l�y.. � _____".-._.-_______ Installation will serve;, Residence DIApahr1ient House-F] Commercial frailer Court iE] 4.,�Motel ❑ Other _.__----_-__ Number of living units:------- Number of bedrooms ___.__Garbage Grinder ----_ __._ Lot Size _goals____________________ Water Supply: Public System and name ------------ -------------- f ._ - Private ❑ .. Character of soil to a depth of 3 feet: Sand'E- Silt❑ l Clay ❑; YPeat❑-- Sandy-Loam. ❑ Clay Loam :❑ I `Hardpan ❑I Adobe i0 Fill M.aterial ______.___ If yes,type ________________________-_ [PI'ot plan, sHowing �ize! of lot, location of system in relation to well`, buildings, etc mu't be placed on reverse side.) NEW INSTALL; TION: ' (No septic tank or seepage pit permitted if p blibiAver idavailable within 200 feet,) ° ! � -- X��` 'ti.................:'-Liquid Depth . -��t�---•-_•-------- 0) k PACKAGE TREA IUIENT Ga a�EP � NK T e __ e_ Material__�4-Alr___�-Y No! Compartments ___��____. ---- yc� P Y YP i i 1- -"'- Foundation _. __ Pro Line Distance' nearest: W �.. ^: --t �� p_ , t.•_. D' Box __._.��_ --- FilteP Le Agth sof beach line- LEACHING ,_____��...__._____ Total Length ,: - -Q--------------- I , � Q � 4 .. Lines _ Type IUjerial I` -_Depth Filter Material -_- �_________�________________ 11N! o, o - J,3.. ---- Foundation ----/__Q__t..__- Property Line -- ------------------ J1 -- y S. k SEEPAGE PIT aw:Depth Distance .mss/ D ameter 3?. Number �_ ^� ._ ____: Rock Filled Yes No i❑ Nater Table Dept --- --------Rock Size _12- ,lY ; t i �i Distance to neares-tLWell ----------------1.1__________-__----Foundation --16___f`_____ Prop. Line --.>----------_0L_ 1i �1 i # - REPAIR/ADDITION(Prev. ;Sanitation Permit �-------------------- -- --------------- Date _____-..__________ .-____-_______) E e SepticTank (Specify Requireme,nts) -- ---- ---------------------------------------------------------------------------------==-------- ---------------------------- Disposal Field (Specify Requirements) ---------------------------e -]----------------------------- --------------------- kk ------------------------------------------------------- ---------------i--------------------------- -------- - ------------------------------------------------------------- t ----------------------------------- ' - -----------I--------------------------------------------- ------------------------------------------- I 1 (Draw existing and requiled addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance wltK q " County Ordinances, State Laws, and Rules and Regulations.of the San Joaquin local Health District. Home owner or licen- sed agents signature certifies the follovi ing: "I certify that in the performance of the work for whichthis permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." r Signed ------------------- - Owner r BY - --- ----- r ------------------------- Title - ---------------------------------- ,k erI /rn - -- thern owner) '1 - - FOR C?EPAktMENT USE ONLY APPLICATION ACCEPTED BY ---Cr__ - !---------------------------------. DATE-d:--7!7 --------------------------- BUILDINGPERMIT ISSUED ----------- ------ - ---------- -----------------------_DATE ------------------------------------------ yADDITIONAL COMMENTS ----------- ----------------------------------------------------- k----------------------- --------------------------------------------------------- } �" ° - _ =_ `-' = {z? --�----- ------------ ---------------------------- --------------------------------------- ----- --- r --------- \---=-` -------------- ---------- ----lT ?� Final Inspection by. 4 s ----- -- --------------- Date.��_ ------G_ SAN-JOAQU!ffCAL HEALTH DISTRICT L 1 E. H. 9 1-'68 Rev.