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# FOR OFFICE LISE, <br /> r <br /> APPLICATION FOR SANITATION <br /> .................. : ON PERMIT <br /> .s .e.... �........:.........:.......: _ <br /> (Complete in.Triplicate} e Na <br /> :1� 5.....:�.:..�. . . Perm <br /> Issued <br /> aced �... ,.::..: . <br /> ... This Permit Ex intro t Year horst Deft Issued Da . <br /> Application'is heribyy made to the San Joaquin Local Health District for a permit to construct and install the work hereto <br /> described, This applieatl n made in compliance with County Ordinance No. 549 and existing Rules and Regulotlonst <br /> DDRfSS/LOCAT#ONde..;af. ...V.ne., r... <br /> p X* 4a. . . ..cls .r................CENSUS TRACT .....:................... <br /> Owner's Name Jimmie Winchel.Z..: .».. .... <br /> 3`� 5... Main ..................Phone .................................... <br /> Address .: .. . ' ...................................................................... City <br /> . . • ..................... <br /> ................ <br /> se# ... ..... Phono'4b5= C16'CorWactor's Nave .....JZa-t-Q.. :,. :3 �r.i. ... .................. .Licen <br /> ; <br /> lnstallatton will serve: Residence 10 Apartment HouseE Commerdal E3Trallor Caul <br /> tMotel L7 Other....... ........................... <br /> Number of living,.units,.........:. Number of bedrooms 3. ..Csar a e Cninder Y.eS:.... tot size _.bY.:.?.��.:� <br /> 4 Calif'. Water ..... . +..•• <br /> Water Supply; Public System and Warne .::.M.:... .... .....w.......... er .....»:......:..:...,..Private 13, <br /> Character of sail to a depth of 3 foot: Sand Silt clay Peat Sandy Loans E3 Clay Loam Q <br /> � 'C7 D y D D <br /> Hardpan Adobe t.,' Fill Matorlof .Q:.::.,.If vas,type.....:......:............... <br /> (Plot plan, ahawing vizi of 'lot, location of system -in relation for wells, buildings, ate. must be placed on revarse WWW <br /> NEW iNStA4U1TlONt (No septic tank or seepage pit permitted If public sewer is available within 200 feat# <br /> NEW INSt <br /> PACKAGE TREATMENT SEPTIC TAfWi; <br /> hb b <br /> l 7 z 2 0 0 � r` Size 41..... .5.?:.. y..... <br /> t.:.: Liquid Depth :....:......,,..., <br /> Capacity ..:........... <br /> ... Tyt�....................as t M+aterlol...c on c r e t e No. Gomp�arhttentIL <br /> ;• 2....:..........:.." <br /> LEACHING' ' Distance,to nearest, Well ....:,??�a;,..,...toug anon ....�.4':.:.:.,.. Profs.Line.. <br /> LINE t No. of tines ...... ... . Length of each line..............and..,85 Notal. 1 7 c t.... <br /> V. Box 8.8. ,� a Filter Material -• p to• Material 1 ........... i <br /> i Yp ,De Depth Fi! ► .............................. <br /> Distance to nea_r�st; Well .... .n/.a........ Foundation ...... .o i........... Property Lina 5.t.............. » G <br /> SEEPAGE J i 'Pepth 4.5.1.............. Aiarneter 3-a! ...:. Number 2 .. Filled Yes E3 No Q1101 <br /> � <br /> Y Water Table Depth ... I. <br /> ...........................»............. Size .......... - <br /> Distance to nearest: Well ..R,!_a. . ..................Fou .... hop. Line <br /> EPANADDITION'iPrev, Sanitation. Permit# ..:.... Data <br /> SepticTank (Specify Requirements),...:.. :.... ................:.:..:.:.:.:... ..................... .,...». . <br /> Disposal Field (Specify Requirements) .•......... ........ ........................ .. . ' ..:..... ............. ..:..:...... :., . ._:..........: <br /> 7.. . ................................................... --- .... .....•---....... .......... ........._.............. .. ..... ..: <br /> (Draw existing and required addition on reverse side) <br /> i .. . . ... . <br /> I hereby certify that I have prepared this application and that "* W6& <br /> will be doneM cmordance whit liars *Mggt" J <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Noma owner or Rom <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work-for,which this permN H issued, 1 shall not *ntplotr <br /> any person in such inamtaf <br /> as to become subject to Workman's Compens flan laws of California." t <br /> Signed ...................... .... ...................... .------- ---- ---•--........... Owner " <br /> By ...........................: :. �.. . title Contractor <br /> Ilfof n awnerl ' ------. ----.. ..... .: ............... ............................................ <br /> MR DEPARTMENT USE ONLY <br /> APPLICATION �IrPTED BY ......�,.. � i <br /> .... ..... ...----.. DATE ..../ :.-L....... ...... <br /> ...... .. <br /> BUILDING PERM T ISSUED.......................... ...........................................................................DATE ...............1--.11.1.......... <br /> ADDITIONAL. COMMENT.. . ...... ... ......... <br /> .. ......:..:.......... <br /> ........................ ............ ... ..... -.....1.... a*'"`"'. ............................... <br /> .. ....... ...................... ......1-1-1—..................................................... <br /> ..................................................................... ............... ...- .. . <br /> ... ..... <br /> Final Inspection by: ,i � <br /> . ...... .....:... <br /> .... ........./2C <br /> .. ��::..: �...........Date ..f <br /> >H 13 2h 1-68 Rev. 5 � l �f�:��......... <br /> S OAQUIN L CAL HE TH DISTRICT 8/74, 3H <br />