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FOR OFFICE USE:� APP1I�CATION`-FOR SANITATION PERMIT <br /> y <br /> ........................ <br /> (Co in Triplicate) Permit No. .7-�-r�� , <br /> ....... <br /> ..,..---..•_....--•----•.---------...Ithis permit Expires 1 Year From hate issued �.Da e�ssued:�_._.-..r-- - <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 dr d`existing Rules and Regulations: <br /> JOB ADDRESS LOCATION _ r <br /> l •�. �. . . ��' ,�, Q�.> �4N_... <br /> i _ ._ ....................CENSUS TRACT r <br /> x . . .....,---.... _ .ry.. <br /> Address ! t .. ..Phone <br /> :t.?:. fyj f ' City t <br /> Coritraftor's Name / :.../ Q ,�r _ �. <br /> License #. !� <br /> Installation will serve: F ' <br /> Resid&nce,M'Apartment House fl <br /> Commercial nT ail r Caurt ;[] � <br /> t 4'Mote'l ❑;Other <br /> Number - <br /> of living units:.__:/-- -_ Numiaer .of..bedrooms <br /> is----Garbage Grinder, o <br /> WIater Supply: Public System and narrre .. ( L 1 $ e <br /> + X !� . <br /> i <br /> _. <br /> PrEvate ❑ <br /> Character of soil to a depth of 3 feet:' Sand { <br /> y... . r] Silt C3 Clay Q Peat 0 Sandy l.oarti {j Cl'a Lo <br /> 4 Hardpa� n YEj 'Acle Fill Material If yea;tyre' y am D ; �' <br /> s I` ��. k <br /> t (Plot Ian sh <br /> p owing size .of.. lot, ,location- of. system,in;relation .,Ito wells, ,b6ildin s, .etc. must,be.,pl{aced-on:,reverse.side.j. <br /> NEW.INSTALLATION: p <br /> {No se tic tank or;seepage pit permltted rf'.pul lic sewer is available within 200 feet,] <br /> PACKAGE TREATMENT ( .1 SEPTIC K.TAN <br /> 5iae -�_s��.✓'.�`... .......� �_kiquid •.Depth ` <br /> Capacity) Type . ._ <br /> Material-"-/7 � <br /> ^^� Distance to nearest. Well --.--- Na iC <br /> ompartp e`t s '�- <br /> .._......_ oundation ...1 :.. <br /> 11=ACH'fNG•LINE � l Pr <br /> No. of Lines f <br /> F Length ofi ch line._ _ -,.. <br /> o ne <br /> -••. - -- dotal Length ..�_.�.. / <br /> l D' Box ./ . Type Filter Material term <br /> •k epth, Filter Material <br /> ` Distance to nearest: Well , •• -• <br /> 6 :.. Foundation __.... - _..._. Pro erty Line a LA k <br /> SEEPAGE PITN <br /> Depth. ���---.- Diameter ;,. <br /> 3 -- umber <br /> ........... Rock Filled' Yes ' No, i <br /> Water .Table Depth. .. s _ f �i� <br /> s = ......Rock ---••-••---- <br /> - ..-. 5iie „� <br /> flistance-ta•'nearssf:�Weil-�--•--:- F <br /> I . - <br /> oundation -:/Q p .............{ <br /> •• :__ Pro :line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# <br /> - _ Date ....:............................. <br /> ! a <br /> Se sic tank ) . . <br /> P (Specify Requirements) _....---A....__ <br /> Dis osal Field S eci .-- .................................— e l <br /> p _I p fY Req meats} ( .i ✓�� J" <br /> ,_ <br /> , <br /> , <br /> ....................... <br /> - <br /> I hereby cerci that I hav {Draw existing and required addition-on reverse sidej� <br /> FY a prepared;this :application and that the work will be done 'In accordance .with San Joaquin <br /> County Ordinbnces, State'Laws;'and Rules and Regulations of the.San Jod'qum Loco' HepliODIstrict.Home owner or'licen- <br /> sed.agents signature certiFies,the following. - 1 ' r <br /> "I certify that'in fhe pe' rformarice of the work for which this permit is issued;I shall 'not em la any a to become", to Workrtidn'i Compensation laws of Galifornio."'"' p y Y person In such manner <br /> Signed <br /> -= Owner 1 <br /> f oth an owner � -•- � -• � •• ••- <br /> t FOR:DEPARTMENT USE ONLY ; <br /> APPLICATION ACC <br /> EPT <br /> ED 'BY r' <br /> BUILDING. PERMIT ISSUED "- ---- -- ------ ---•- :-- <br /> :� TE _ <br /> s3 <br /> ADDITIONAL COMMENTS --- - <br /> �DATI: •) <br /> ....... ...................................... .. <br /> Final Inspection by: . <br /> -- Date <br /> SAN JOAQUIN LOCAL' HEACik DISTRICT <br /> ._ . i i i__ ••p <br /> E. H.13 24 1-'68 Rev. . .. .. <br /> SM _ �✓ <br />