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- �' t FOR OFFICE USE APPI.ICATIION FOR SANITATION! PERMIT S Permit No. _7�---� i (Complete in Triplicate) ----------'------- ------------ �, a.--------------- E Date Issued s This Permit Expires ires 1 Year From Date Issued Application is herebyrmade to the'SanJAcquin Local Health District for a permit to construct and install the work herein ' described. This application is made incompliance with County Ordinance No. 549 and existing Rules and Regulations: IM/Yl` JOB ADDRESS/LOCATION ._l ._' _ �: '' --- ------------------ CENSUS TRACT _-•----------- •--_-- . l -----Phone �----"�' -- Owner's Name __!!��//�J� = -------�7��7� 1 _: �. �,--- Address ------ - `i --=- � 1�/+ 4 ------�i /_ _. City _� � %ArX--------------------------------��-- 3 o -� Contractor's Name --- -- - --------------------------------------License # �- Phone �� I Installation will serve: Residence [A Apartment House^❑ CommercialE ❑Trailer Court i❑ 4_ Motel F-1 Other ----------------- ------------- --- - --- Number of living units:._._ _ __,__ Number of bedrooms ___l�---Garbage Grinder ___ ----- Lot Size Water Supply: Public System and name ------------ - - ---------------------------------------------------------- --•--------.----------Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑E Sandy Loam ❑ Clay Loam ❑ r Hardpan ❑ Adobe ❑ Fill Materia! ---- If yes,type __.__._____— (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if plublic,seler,is available within 200 feet,) r PACKAGE,TR ATMENT [ ] SEPTIC TANK[ I Size--------- -------------I----------------------- - Liquid'Depth _____-________- -------- O `' ` TYRe• '---------- Material ---------------- No. Compartments ---------------------- Capacity b1 ,. r a % f� [ Distance. to nearest: Well ------------------------------------Fo hndati n -----------------t---- Prop. Lime -----------.---..-.-- Length of each line.--- ------------- Total Length _+ .----------___-.. ;�- LtAC-KING LINE [ } No. of Lines _____ ______ f � II � ) . e /�, I 'D' Box .�.�.�-- Type Filter Materia! _ D_c�________Depth Filter. Material _� ________------------------___________ Distance to nearest: Well __/r_ _____-_-____ Foundation. _. G'-------------- Property Line _�__________._._- SEEPAGE PIT [ Depth _!_________________ Diameter __________ ---- Number - 1--------------.---------- Rock Filled Yes ❑ No 0 + . ---------------------------- Distance i Water Table Depth ---- --------------------------------- --------Rock Size --------------------------- Distance�to nearest: Wel!4------------------------------'-------Foundation -------------------- Prop. Line --------- -------- F T REPAIR/ADDITION(Prev. Sanitation Permit# _._.__,_.------------------------------- ---- Date --------._.-----------------------I t i Septic Tank (Specify Requirements) ------------------ --------------------------------------------- ------------------ ---- --- ---------- J j DiWosal. lel (Specify Requirements) �%! _//fr`/ --1-r -= l - ��f i- - -- -- - t (Draw existing and required additio-ri;-H rse side) « , I hereby certify that 1 have prepared this application and that the work will lbe done in accordance:wish San Joaquin County Ord nances-,—S—G a Laws,Jand Rules and Regulations of the SanIJoaq in` Local Health District. Home,.owner o'r licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued ) shal4 not employ any person-in such manner as to becon e�subject to Workman's Compensation haws•of California." Signed ° Owner 1A BY n. G7v L'e - Title �dQ �` ! (I`f of er than 6ow � `i'��" f t FOR,.DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY f r € . DATE �r- 1 ' DATEBUILDING ,.ERMIT ISSUED --------`h---- ----- --- ---M-=--- ------ -�------�-�---y-------�---�--�--------------------- ----- ADDITIONALC -------------------------------------- Wit- •- cr'a ` ------------- ---- - ------------------ ------------------ ------------------------------------------------------------ ------ ------ - ------- --------------------- - ----------------- ------------------------------------------- -- -- -- - - ---------- - ---------- - �M--------------- � '�'_-�/. Final Inspection by; --------- - ----= ---�--�^�--'�--��-------------------------------------------------EI --------.Date ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT _ - ---_ E. H. 9 1-'68 Rev. 5M