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� FOR OFFICE USE. - APPLICATION ICOR SANITATION PERMIT ...................................................... ete In Triplicate!, Permit iComplNa. . a a lF ................. •i -This Permit Expire'1 Year From Dow Issued: • ,:., Date lasued ._ . _ - �.! T Ora- (?o --cz' A Applicatio9n is hereby made to the'S4ai3 Joaquin Local Health District':for"'o permit to construct and install the work herein i described. This application is made in'compliance with'County'Ordinance No. 549 and existing Rules.and Regulations: JOB Ii i ADDRESS/LOCATIONi ,; ... " ......CENSUS TRACT ................... ........ ....Phone .................. ...Owner`s Name' - €y ..Address ..... I . " ma ............. ................. .. .. Contractor's Name -•`.... _. .. .....License d•` ZhEM Phone .............. ............... installation will serve: , Residence j A a'rtment House C] Commercial❑Trailer Court.'i❑' �f Motel"(]C1the� . F Number of living units:-----j..'.' Nun'nber'of:bedrooms Y-.:Garba a Grinder _ Lot Size ... .__ ---- ,��] Water Supply: Public Systerri and name �. ....... � ,:.ffCl.... ...._.. ..............Private ❑e Character of soil wa depth"of 3 feet Sand Q Silt Q'. -CloyT(] i�-,Peat Q- Sandy loam 0'Clay Loam 0 € Hardpan Q! Adabd Q FIII Material ...._.......1f yes,type .............. ............ t. .- (Mot plan,' showing size"of "lotf location of'system in relation so" wells, buildings, etc."must be placed-on reverse side.) Q' NEW INSTALLATION: (No septic tank or seepage - it permitted If public sewer is available within 200 feet,) PACKAGE=TREATMENT' [ ] SEPTIC TANK P P Sire q Depth - -- Li � 4 Capacity --...----- •.... TYp�----- -` Material....:.:....:.:. :... No. Compartments .. A Distance to nearest: Well -------------- " Foundation Prop. Line _ ----- i LEACHING LINE No. of Lines Len th of each line............................ Total'.Length .. D 'Box: ........... Type Fi#ter Material-,..........:'......,.Depth..Filter-.Material-�_--•.z-....:..:.......................... Distance tonearest: Well .:.. � � . , �.._ ' • -•-.-...: Foundation-=_._ " Property �Llne•:.......:............ SEEPAGE PIT [ i 'De ... `...... _.... N � Diameter ..:............. umber __ Rock Filled Yes ❑ No Watee icible' Depth-'..... ----- -_ ; _.. .: 'Rock Size Distance to'nearest: Well ... : ......... ` ` i_ ....Foundation _--• __. .... _. Prop. Line s i .. ... ......................- � REPAIR/ADDITION(Prev. Sanitation Permit+#...... ................ I Date.__ --... :...... ....� f „ ..' ..... _ ,.Septic Tank (Spec€fy.Regiirernents)....- - . . ................... ....._...._•__ .......... 'Disposal Field (SpecifyRequirement r - --�----- - -------- ---------------- --- - •-� ----�-- ---_----- ---------_ .............. ..-•- 4----••-------=--.... _ _--- -- ----------------- (Draw ex' � istino and-required addition on reverse side! i . I hereby certify that I L have prepared this,opplication i and th at the-work will be done'In accordance with San Joaquier County Ordinances,' State Laws;and Rules and Regvlatiens of the Son Joaci0n Local Health.District. Home owner or licen- secl agents signature certifies the foltowirigs' � ..�:, �_"� "� - � i {� - . f "I;certify that In the performance ofthe work for"which this permit is Issued,] shall not employ any person in'such manner as to become subject to Workman's Compensation laws of California." i i Signed�. i ............. Owner I ! - -- r - i Q/y1 By, .4 i (If other than owner! e 1 ................. DEPARTMENTI,MSE�ONLY;. APPLICATION 'ACCEPTED BY -- f i -- - `. .__.s....-..-DATE BUILDING PERMIT ISSUED ._.. - -----__.._ _ ._ ------ ----- DAT :-.... - ............ AD AL MMENT5 .. ?- ... ?." 1 �""'p �5 .........-. ...----G- a .•;..___err �L' - '�-------._...._.._._...................... --- •--------------•--------------------------------------------.-..._....--....._._.-------------- ---- ........ Final Inspection b = Date .'?.�y P Yt . ..... EH 13 24 1--68 r,4--v. 5M SAN JOAQUIN -LOCAL HEALTH "DISTRICT 8/7$ 3M