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FOR OFFICE USE: - <br /> `.... .............. APPLICATION FOR SAN fTAT fON PERMIT <br /> ±� (Complete in Triplicate] Permit No. _-{_ ?�j q, <br /> .................................................... <br /> .............••••------- ------ This Permit Expires 1 Year From Date Issued '" /A Date Iss ed ._Y-n.�P_� <br /> /4 � _ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work ereln <br /> } described. This aplicotion is ma a in m lianc 'ivt un y Ordinance = <br /> ' e No. 549 and existing Rules and Regulations- <br /> JOB <br /> JOB ADDRESS/LOCATION - •' .,•_.. . - <br /> I Owner's Name .__... . �..._.... ...... -...-..Fq._.. .......................... <br /> • T <br /> _ •---- .............. ...... .••• ........ e <br /> A <br /> ......Phone S.�� S o� c�G <br /> I Address -----3. ©. M AZA (� •--- <br /> . ..�.._.�...... -------------- -- City ---••--- ------ - . . <br /> Contractor's Name �- .... . <br /> .................................. <br /> --•.License # �9.._.. <br /> ;.. Phone <br /> Installation will serve: Residence's Apartment House l] Commercial 0Trailer Court w. . - <br /> Motel ❑Other............. <br /> g Lot Size. �. °.. f.. .,.., <br /> Number of living units:.___ ------- Number•of bedrooms __Garbage Grinder ..___.._._.. <br /> Water Supply: Public System-and name..... ............. .•--- ---------;-- <br /> --- -_--- --- <br /> Character of soil to a depth of 3 feet: Sand Silt Cla - ...................... .7 - ❑ <br /> .Private <br /> ❑ <br /> ,_ .;�. 1......r,.__ w.. . Peat Sandy Loam ❑ <br /> ❑ Clay Loa <br /> Hardpa FAdobe ,❑ Fill Material r fes, - -� <br /> .........I.................. <br /> (Plot plan, showing size of lot, location of.:system in relation to wells, buildings, etc. must be placed on reverse side.). w <br /> NEW INSTALLATION: �.(No septic tank or seepage pit permitted'if public sewer is available within 200 feet,)' <br /> PACKAGE TREATMENT <br /> [ ] SEPTIC TANK,f4 _ Size... ................ +1_ -..-•-- -Liquid Depth --------- -------•-•-••-- <br /> _Q.°.��o..Q T <br /> U"` T ype - e I Material_ ..----. No.J Compartments .. <br /> Capacity'..[Y' <br /> . <br /> Distance to nearest: yVell <br /> 5_. f <br /> � •• <br /> 0 -•--- ---.�:=--____--.Foundation ....�.b....-f.._.._ Prop. Line <br /> - <br /> LEACHING LINE J' No. of Lines _ <br /> Type Filter Mategrtal/ Z__ `9Fi/ ` Total 'Length "�` <br /> �...-..., Len Length o each li e -- d.._--- <br /> D' Box'.. _...._ T Z <br /> �epth Material ! ..........Distance .. ...- <br /> to nearest: Well . - <br /> r..:__.-y Foundation �� <br /> _....�_...:_....•--�---.. Property Line <br /> SEEPAGE PIT Depth ---/.,Q Diameter ............er '.=Kluri"t6a• _ <br /> I, l ......_• .Rock,Filled ..Yes.'b,.,<;.,No..0 <br /> Water Table Depth .................. <br /> -----•-•---••...............:.Rock Size .-•....... <br /> X (?x'/Q Distance to nearest: Well --------••---•---:.._. .............Foundation ................. <br /> pMp Lute ............-......... <br /> REPAIR/ADDITIONti <br /> it <br /> Sa <br /> Prev. Sanitation'Permit�# <br /> ( '° . Date � <br /> Septic Tank (Specify Requirements) ............... ..............•---_-- <br /> Disposal Field (Specify Requirements) �� ^ _...__. ..........._----------------• <br /> ........................... .....•--- -_ -` --.:. " - - `� r- •• - '. ..... <br /> (Draw existing*d requ.ired-additionTon reverse side) <br /> 00untby certify that [ h v r pared this pl' tion and that the work 'wolf be done in accordance with San Joaquin <br /> Ggunty Ordinances, s, and Ru a Regulations of.the San Joaquin Local Health District. Home owner or licen- <br /> sed agents sign r i the folio <br /> 'it certify that o w k for which this permit is issued, I shalemploy l ^ot { <br /> as to ome ct r aCalifornia." 4 <br /> P Y an y .person in such manner <br /> i nsation laws of Clifi <br /> Signed <br /> By .. ..... ..... .. .......... 0wneA,M <br /> •---••--- _� tl <br /> �... �i a ..__.. - ?. <br /> 1 <br /> ` {If,o er t n owner) . .............................. . ...................... � "3 <br /> '1 ORD RTMENT US ONLY - <br /> APPLICATION <br /> NLY,APPLICATION ACCEPTED BY _.. ......... <br /> .--- ••-------- --- DAT - <br /> BUILDING PERMIT ISSUED ... ..._.. . -- ...__..�. <br /> ADDITIONAL COMMENTS ,l ................. ........•-----•••:_•---. ---••- = ...:. ATE _ <br /> _lei......... .. ; 4 <br /> •-�--- •• <br /> '� <br /> ................ _ --• <br /> .................................•-•---......------.... <br /> Final Inspection byr1t, ---.._.... <br /> -- ---..... Date- "` ':.7 ..----- <br /> Y SAN-JOAQUIN LOCAL HEALTH .DISTRICT <br /> E. H.13 24 1-'68 Rev. 5Ma! f <br />