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_ .. 'o <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT '/ o <br /> .. ... ............ . . <br /> Permit No .17."..(.T..S. <br /> . . ........ <br /> ]Complete In Tdpl;aote) <br /> ....... .......................... d / <br /> .. . ... . ........ ................ <br /> ..... TAis Permhlapires 1 rear from Date Issued Date I»ued J.....:..7'7. <br /> Application Is hereby made to the San Jooquin Local Health District for a permit to Cal"4%d and Install the work herein <br /> described.This application is made In compliance with County Orrdinar:.e No. 549 and esOng� cps Rpulations: <br /> JOB ADDR°ss/LOCA ON I... )/1.Ot!"a.eJ...p.vv..?5rrefo Pve/ed.....�!!rt7T.7...CENSUS, TRAA/f� —Y--........,_ <br /> Owner's Noma ..... l�I�..i-....... f.QIXJ!tl.I✓ ......._...._. .................................Ohone�Ji��— - <br /> 2n o ....... ..........- _..._Lily .. li2 _1�......._....----••.--.. <br /> Address /,/ O �/ p� <br /> Contractor's Name... t .-....... ..-0A� �. ••lr............_.........._..._Lkanw�f�,�I9Q.... Phone <br /> Installation will serve: Residence%Apartment House EJ Commercial QTrollerGant ❑ ; <br /> Motel❑Otter.. .. .... ................................. .._..... <br /> Number of living units,.../----- Number oI bedrooms ...2. ..CGorbage Grinder Lot Stn ..C"X-1* <br /> r. Wow Supply: Public System and name .................._.... <br /> ......_� .... ....... ..............._ ._...._. .Private <br /> Ca:atterof soil toodepthof 3 feet: SondIRSilt❑ ClayQ P�Q Sandyloam❑ doyloom❑ <br /> "Ll <br /> Hardpan❑ Adobe ❑ fill Motorlal _ If yes.type ................ <br /> (plot plan, showing size of lot, location of system in relation to wells, buildings, etc must be placed on reverse side.) <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted If public sewer is available within 200 feet) <br /> PACKAGE TREATMENT i 1 SEPTIC TANK I 1 Size.............. ..... /;on, <br /> . . ... . Liquid Depth ........ ............... <br /> Capacity -. ..... . . . Type ........ rial. .. No. CompaAmoin ........... <br /> Distance to nenresh Well . .. ............. . ... ............ Prop. Line..._....... <br /> _.w... <br /> LEACHING LINE ( 1 No. of Unes .. Length a eoch line .. Total Length .__.........._._.._._. <br /> Boa .... .. Type Filter Material ........._....... pth Filter Material .................... <br /> _ <br /> ` Dis:cent to nearest- Well ............. ........ otion Property line ._..........._.�.. <br /> SEEPAGE PIT ( ( Depth _ ... ... . Diameter .......---... be• Rack Plied Yes ❑ No C <br /> vyater Table Depth . ........_..... ............Rock Size _......_.....I.... ..I.. <br /> Distance to "ores'. x <br /> ... _.__._ .....Foundation . .. .............. Prop. Lir»RE►AIR/ADDITION(Prey. Sanitation Permit f .... .. .. . _. Daft . ..............................Septic Tank (Specify Requirements) . ._ ... . ....... ._ ... .._.. ...._... . .... .. ... . .._._........,.... <br /> Disposal Field ISpecify Requirements) --.. .. - .... ..... .. . .. . . <br /> iDrow*Acing and required addition on reverse side) <br /> I hereby certify that I have prepared this opplicatten and that the work wIR he done In accordance with Son JeegvlP <br /> County Ordinances, State Laws, and Rut" and Regulations of the San Joaquin Local HeaHh District. Home ewnor or lice- <br /> sed agents signature tortillas the followingv <br /> "1 certify that In the performance of the work for whish This permit is loved, 1 shall net employ any "Son {n we Manner <br /> as to become subloct to WCompensation laws of Callfemlo." <br /> SignJitk <br /> -d <br /> /f'/ r _ Owner <br /> (If other than owner) <br /> COR DEPARTMENT VSE ONLY <br /> s. APPLICATION ACCEPTED BY __7P"4Z - DATE <br /> BUILDING PERMIT ISSUED DATE <br /> ADDITIONAL COMMENTS - — <br /> s� GJ�G7/.� <br /> Final Inspection by, "� Date <br /> SAN JOAQUIN LOCM ni ALTH DISTRICT <br /> r <br /> E. H. 9 1-'68 Rev. SM <br />