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FOR OFFICE USE: <br /> -- --- --- -------------------- ---------- --------------- APPLICATION-FOR SANITATION PERMIT Permit I .No. _ _- 733 <br /> (Complete in Triplicate) ------------- <br /> .......... ------ - y y <br /> ---T-- <br /> �. <br /> s' sued _Y.----21 <br /> This Permit Expires I Year From Date Issued Date <br /> -------------------------------------------------- <br /> ------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> de.scribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.. <br /> JOB ADDRESS/LOCATION ------ ------CENSUS TRACT' <br /> ------------------- <br /> ------------------- Phone�C_ ......... ----------I------------ ---------- <br /> -Owner's Name ---CU_f�_LE ----0`_J--"---- <br /> Address ------------5--V-3------ I -------- ------• city---------- <br /> -------------------------------------- <br /> Cohtractor's Name ------00_WJV_V=_?--------------------------------------------------------------License <br /> --------------------- Phone ------------------------------ <br /> Insta.1lation will serve: Residence E] Apartment House,E] Commercial EjTrairl-r Court F1 <br /> Motel []Other .4i/k/_!5----- <br /> ,--Number of living units:_.---.----- Number of bedrooms __--____--_Garbage Grinder <br /> Lot Size -------------------------------------------- <br /> Water Supply: Public System and name ------------------------------------------------------------- ------4- = Private E] <br /> Character of soil to a depth of 3 feet: Sand'o Silt 0 Clay E] Peat❑'-.Sancly Loam Clay Loam E] <br /> Hardpan E] Adobe [7] Fill Material'1 If yes, type ------------------------ <br /> a�• <br /> (.Plot'plan,-showing size of lot, location of system in relation to wells, buildiligs, etc. must be placed on reverse side.). <br /> ..-.,NEW INSTALLATION-I (Noseptic tank or seepage pit i ed pub perm'' .1,-c seweris available within 200 feet,)i <br /> PACKAGE TREATMENT SEPTIC TANK[ ze---------------------- i ----------------- iquid Depth -------------------------- r1*% <br /> -------- No. Compartments ----------------_-_ 1��, <br /> Capacity -------------------- -Type. ------ Material <br /> Distance to nearest:,Well ---------- --------- ------Foundation -------------- ------- Prop, Line ---------------------- <br /> LEACHING LINE No. of Lines -------------------- Length of.,eacAlline''111 ------------------- T tal Length ---------------------------- <br /> • 'D' Box ----- ------ Type Filter Materia --------- ------Depth Filter,Materii il -------------------------------------------- <br /> Distance to nearest: Well ---------------- ------- F6undation ------------------------ Property Line --------------------_- <br /> ❑ N o Cj- <br /> SEEPAGE PIT Depth -------------------- Diameter -------- ..Numb r ----------------------------- ock Filled Yes <br /> 1.16 <br /> Water Table Depth -----------------------------I-------------- -,-Rock Size ----------------- -------------- <br /> Distance to nearest: Well ------- --------------Foundation -----------V_�--- Prop. Line ----------- ....... <br /> 7 <br /> -Date ------------------------ -- ---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----- <br /> Septic Tank (Specify Requirements) ----------------------------------------�!Fp---------------- ----------------------------------------------------------------------------------- <br /> O <br /> Disposal Field (Specify Requirements) --------------711VJp _MRS------ <br /> ------------------------------ -------- I--------------- <br /> A------------------------------------------------------------------ <br /> --------z------------or—------------ :-�,WVA <br /> n reverse side) <br /> (Draw existing-and required addition- 'r <br /> I hereby certify that I have prepared this application andfliat the work. will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Reg UlatioAS of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following- <br /> "I certify that in the performance of the work forwhich thii-'permit is issued, I shall not employ any person in such manner <br /> .. V—. , -- , -Ir . <br /> as to become subject to Workman's Compensati4m laws.of Xailifornia.",� <br /> Signed ------------------------------------------------------------------ -A--------------- Owner <br /> By ---- -- - --- --------------------------------------------------------- ------ Title -- -- --- --- ------ <br /> (if other than owner) <br /> FOR:DEPARTMENT USE <br /> ----------- "- ----------------------------------------------:ACCEPTED BY�------7-1-9, C::t __1 DATE ----- <br /> BUILDING PERMIT ISSUED --- --------------------------------------------------------------------------------------­--------------DATE ----- ..................... .......... <br /> ------------7-----------w�-- -------------------------------------------------------------------------------- ------------------- <br /> ADDITIONAL COMMENTS 7 t * ., I -- <br /> ---------------------------------- -------- - ----------------------I ------- --- - -- ----------- ------------------------------------------------------------------------------------ <br /> ----------------------- --------- ---------------- ------- ----I-- - ------------------------------------------------------------------------------------------------- <br /> ----------------- ---------------- ----- ----- ------ ------- ------ --- -------------------------------------------------- <br /> Finbl Ir on #I-.. -- ---- -- ------ -----------------------------Date ------- ----------- <br /> 7 %W---- <br /> 4 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> CIQ� <br /> E. H. 9 1-'68 Rev. 5M <br />