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FOR OFFICE USE: <br /> % APPLICATION FOR SANITATION PERMIT (� C� I <br /> 1/ Permit No. .. . a........ .. <br /> • - (Complete in Triplicate) <br /> . ......................I..... . ..... V�Dote Issued ...I.J�'�� <br /> This Permit Expires 1 Year From Date Issued M�• /n /H�/ �(Q t <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work ereln I <br /> ' described. This application is made in �gm?io w't un y Ordinance No. 549 and existing Rules and Regulations: <br /> ,f <br /> PP <br /> �r>_ ) -5 .ir�FGcENSUS TRACT ............... .....4y� .... <br /> JOB ADDRESS/LOCATION ... G'r --. �fT � / ... ... . S�Z • <br /> sc •�'—^ ,. ...........Phone ........... ...... ............. <br /> Owner's Ncme ......p.-....is! Q........ .. y..V4A..�! <br /> ..... <br /> ..... <br /> . .... ... .. <br /> 3. .Q..C) .. ......-... ........ ............ t!�t,................ y ................ <br /> Address — f.......... <br /> c t °hone ............... .. ..... <br /> Contractor's Name ...c1/t ......License # a -I --G `s� <br /> . ......P�.s....1 .g4�v ........................... <br /> Installation will serve: Residence(Apartment House C] Commercial ❑Traller Court ❑ <br /> �.. <br /> Motel ❑Other ............................................... <br /> Number of living units:... ....... Number of bedrooms ........Garbage Grinder ............ Lot Size .... .. . <br /> Water Supply: Public System and name ................................... ........... <br /> ....................... <br /> Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt t] Clay ❑ Peat F] Sandy Loam C1Clay Loa <br /> Hcrcipan Adohe ❑ Fill Material ............ If yes,type............................ J <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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> (SEPTIC TANK /� C A L. <br /> [ <br /> i:�Q :iize...:..}i.`1.0.. .. ........ ........ ........ Liquid Depth .......................... <br /> PACKAGE TREATMENT -{� <br /> - �fJrc�ll�((No. Compartments C% <br /> Capacity ° Type `LZ' .-.�l�P atcnol. J , J <br /> P +v . b°..... /r <br /> i <br /> .-Foundation ..../.() Prop. line:.�- <br /> Distance to nearest: ell .. ..�..�.•.-•. - .-•-- • �r <br /> .. ........... Length of each ipe ..�.C/.....-. ...`� rotal Length Z.k{................ <br /> LEACHING LINE No. of Lines Q c-_ <br /> D' Box ..f...... Type Filter Materiaf/'2.......... -. epth Fi tf I Material .........../..:..........r <br /> i 0..... Property Line ..S-••�......••• <br /> Distance to nearest: Well .��� .... �/ <br /> f...,..., Foundation ...• .- <br /> SEEPAGE PIT Depth .../.0..••••••- <br /> Diameter ..�x ... Number ......_1Z............... Rock Filled <br /> Yes . No <br /> �4_ <br /> r�-t�S�-- Water Table Depth ................................................ Size ................................ <br /> /Z X/ b(/o Distance tc nearest: Well ........................................ <br /> Foundation .................... Prop. line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .............................• •• ..... .. Date ..................................) <br /> Septic Tank (Specify Requirementst .......................................................................... ... <br /> Disposal Feld (Specify Requirements) ...... ......./h r <br /> .. <br /> .... ...................................... .. <br /> .... <br /> (brow existing,and required addition on reverse s.d e) <br /> 1 hereby certify that I h9vyt //relpared this OplRation and :hat the work will b-w dont in accordcnee with San Joaquin <br /> Cr�unTy Ore finances, te/ :(vf l Health District. Home owner or licetr <br /> s, and Ru and Regulations of the San Joaquin Loco <br /> sod agents sign r Sti the folio Person in such manner <br /> "i certify that �, i5nz$:of w k for which this permit i; issu� sha/�ll of employ any p <br /> �nsation laws of California." �I ,L M b as to Mme / � F <br /> t / f,L <br /> Signed .: . .... . .. P' �.. .................. .................................. . .. <br /> Title � � <br /> .. .................................... <br /> By (If other t n owner) <br /> / R DEPARTMENT USI* ONLY _ (�" n <br /> l,��C.. DATEI.. <br /> ...�.. <br /> / DATE / <br /> APPLICATION ACCEPTED BY . .Ii.'�......✓. ...�,':....f.................... w•�... _ �/�/ <br /> ................................. <br /> BUILDING PERMIT ISSUED ... ...... ....................................................... .................................. .. /0�5" <br /> ADDITIONAL COMMENTS .I.SZ......lJ.n1........�/r^!.��.....s�..._.7.L....!.v.... ..........1............../� ... ..... <br /> ...::.�.�..... <br /> y+ .... <br /> ..........._................. ....... _ C................6P......... "f./.�.1...........1!�� ......_. <br /> ... .............. <br /> �v z:: �..c.........�..s......... ......... .. <br /> ................................ <br /> .......,.. ... <br /> :71 r <br /> ..G...... .......... <br /> / . ...............Date ...,/ ,a..--..✓ <br /> ............................................ <br /> Finoi inspection by: ....«..........., ............... J.. . <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT C/!� <br /> 7(1J73 3 M <br /> E. H.13 24 1.-68 Rev. 5M <br />