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APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Dale Issued <br />FOR OFFICE UgE: <br />, <br />Owner <br />F:Arz.da.,0 1d9f _ Title <br />(If other than owner) -r.(R 0 ( <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY -rt R-6) <br />BUILDING-PERM-IT--ISSWED---Th <br />ADDITIONAL COMMENTS . 05.P.rti-$! .e1-1 1‹,C;° 74 <br /> <br />f:‘ 2:0'7 <br />Final Inspecti by: <br /> DATE <br />Date <br />— - <br />Permit No. <br />Date Issued <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br />described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />4 <br />JOB ADDRESS/LOCATI%i 313i_7 E___ possi ER_ CENSUS TRACT 6 <br />Owner's Name [1O/7W AlE. 1.>./ Aill Phone <br />Address / 77 q_3''.: S.---,--„UICTTP.R7 City <br />Contractor's Nam.fiGE....1-146;5‘.. SEPT? c TANKS License # 2s-t.3 7 Phone 52V <br />Installation will serve: Residence [artment House ° Commercial OTrailer Court i; I <br />Motel n Other <br />Number of living units: . t . Number of bedrooms 3 Garbage Grinder ......Lot Size #0 A/ /70 <br />Water Supply: Public System and name <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br />NEW INSTALLATION: (No gé pit permitted if public sewerlis available within 200 feet,) septic tank or seepa <br />Distance to nearest: Well '$-0 Foundation PrOp. Line S <br />'D Box7&5 <br />1 <br /> <br />Tyr f ilter Material RacK._..Depth Filter IAaterial • r/ <br />Distance to nearestyW4;11 ,7S- ' Fouriidatian ie --i---- Property, tine -.5 ,-";'41 <br />Depth /1 C"-- , 4iforrefeer VX Number. , V,--- Rock fikill VA,' r i <br />Water Table Depth ,I. ;30. ( <br />Distance to nearest:Vell l0ge- Foundation /0 -1---- 4....e .i.%..." , A ,,,, i__, 1 <br />i \ <br />ItEPAIR/41001111111111 (Prey. S II anitation Permit* Date i cY <br />I. <br />Septic Tank (Specify Requirements) • <br />Private <br />Character of soil to a depth of 3 feet: Sand O Silt El Clay 1] Peat El Sandy Loa Clay Loam <br />Hardpan (e7 Adobe 0 Fill Material ./10 If yes, type <br />PACKAGE TREATMENT [ ] SEPTIC TANK Size r ----Liquicf-Depth <br />Capacity JZC 2 ,.. Type PRECA5T Material CVIVCRT"- No , Compartments ?-- <br />t ,r; <br />e2;tth iline 6-0 t.f.; ,17-Tota1/411 Lenith /00 <br />2 <br />SEEPAGE PIT <br />1-4- <br />(A) <br />, Disposal Field (Specify Requirements) / <br />(Draw exiscting and required addition on reverse side) ' , II. <br />I hereby certify that I have prepared this' application and that the work will be done in accordance, with San Joaquin <br />County Ordinances, State Laws, and Rules/ arid Regulations of the San Joaquin Local Health District. Horne owner or licen- <br />sed agents signature certifies the following d <br />"I certify that in th etiorranceof the work for which this permit is issued, I shall not employ any person in such manner <br />as to becF. e sub to Id cinq' •'1 eeIlotJ laws of California." <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-68 Rev. 5M