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FOR OFFICE USE: APPLICATION, FOR SANITATION PERMIT *— - - Permit.No,. �Q��Q_.--- (Complete in Triplicate) ------------- P Date Issued This Permit Expires 1 Year From Date Issued - ------ - ------ ---- -.. ,7J- d- lance with th-Di ' C> Application+s fie`reby made fo the San todyuiri L"ocahHPdlth-District for a-permit to-consfiruct and install the-work-herein described. This application is made m co p rdinance No. 549 and existing Rules and Regulations: �/_0_ -f �/ __ CENSUS TR CT ,JOB ADDRESS/LOC ON - - �D(�1-��--�`- -__ _..-'`_'""""_"�r-_ ._ f ------ 2 y�2 � __Phone�C 41-- - - ------- Owner's -•--_ Owner's Na e l`-�-- -- _ �� ------------ '� Y Address ( -------- -- �4_hu/ -e City �_ / --License � �� Phone Cl�` • - - . d/ �- , Contractor's Name --- ______________________ ' Installation will serve: Residence Apartment House�❑ Commercial ❑Trailer Court ',❑ . v Motel ❑ Other -------------------------------------------- jj - - Number of living units:.-.-/------ Number of bedrooms ______.Garbage Grinder -_._:___--- Lot Size _. _ '---- Water-.Supply. Public System and name ----------------------- -- - -------- - Pri at v eg t t ❑ ` y Clay Loam .t Character of soil to a depth of 3 feet: Sand' Silt;❑ Clay, []...'Peat Sand Loam ❑ Y .0 Hardpan ❑ Adobe'[:] Fill Material ------------ If yes, type ---------------------------- {Plot plan, showing size of lot�llOcation of;system intrrelation to4wells;�,buildings, etc: must be placed on reverse side.] NEW INSTALLATION: -(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ; P T \ SEPTIC TANK:( 7 Siz --- Liquid Depth -___ -- - Q �- PACKAGE TREATMENT [ 7 - �� 5 ;. --- -r----- •---- -------- - S� capacity 'f o. Compartments ' ..---.....--•-- p: Y -� - --------------- - �- - - - Type -----.------ --- - :: Materia ----u�rdation ="' =----- ------- Prop. Line ------------------------ � = Distance 'to nearest: Well Foundation LEACHING`L1NE No. of Lines"------- -- Leng# o-f each Ione- "�� - Length --------- --•---•-•-- ::. 'D' Box ----- ------ Type Filter Materi l ------------------•:_Depth Filter aterial Distance to#nearest Well ------------- --------- Foundation :-__ -- -- -------- _ ropertY Line ._ :--------...----- ;. s I f j Diameter Number .r- -'Rock Filled---Ye1❑ i. -No �❑7- ri 1. , SEEPAGE PIT [ ] Depth - Water Table Dept4 ----Ro k'Si e- ------ --------------•----•---'-- �. ZFoundatio -------------------- Piop. Line ----------------------- 'Well C Distance to nearest� ____-___ _ --- --------- _. _ REPAIR/ADbITION(Prev. Sanitation Permit'=# ,--_---- ---�P pate ---- --- -------•=-------- 1`. '.i. Septic Tank [Specify•Requirements} ----- ;-- --- ------------------------ ------- -- ------- -- ----- - ........... Disposal Field' (Specify Requirements) ---- � ,�;j Al d n ----------------- - -- A .'{Draw existing and-r.equir_ed_addit.ora_on_reverse.side).�.,_�1 �I l�a i I hereby certify that I have prepared this application and that the Work will, be done to picotHance withSan Joaquin County Ordinances, State Laws, and Rules and Regulations of`the. San Joaquin Local Nea�th�Di#rict. Home owner or licen- sed agents signature.certifies the following: t` "I certify.that in the performance ofd the.work for which this permit is issued, I shall not employ any person in such manner as to become subject.to Workman's-Compensation laws of California.'.' Signed _. -- --------- ; t f_ Owner. �J Title ---------------------- ------ - -------------------- --------- By �f. er't an owner} , i FOR DEPARTMENT USE ONLY. : - , Q DATE •- APPLICATION ACCEPTED BY Irl -'------ - - •----- BUlLDING PERMIT ISSUED - --- -- --- - -L- --- ZS�_ -_i- --------------------- - b1T10NAL-COMMENIS7`--- -� -- - - ----------------- ---- ---DATE ----- AD --- , ----------------- ----- ---- --- _ - ---- ----- ----- -- --- - -- --- ---- - e �J Final Inspec -- -- Date. SAN JOA QUIN LOCAL HEALTH DISTl21CT s; -'66 R v. SM ` E. H. 9