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FOR OFFICE USE: <br />1-'68 Rev. 5M E. H. 9 <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br /> DATE <br />DATE 47/3 9 <br />Signed <br />By <br />If other than owner) <br />. , <br />Title <br />OR DEPARTMENT <br /> Date 4-i g-6 .101' <br />g 3 g <br />Final Inspection by: <br />SAN JOAQUIN LO HEALTH ISTRICT <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />a permit to construct and install the work herein <br />ce -No."`549 and existing -.Rules .and •Regulations:- <br /> ''v.\\ \CENSUS TRACT <br /> Phone <br />v <br />-... <br />..s.,_ . .N.. ............ <br />, / <br />A.C4.-)LiCenZe 6 y Phone g.Z1././.4.-.7_ <br />Residence (Apartment ouse0 Commercial 0Trailer Court 0 <br />"A <br />Motel 0 Other <br />Number of living units. A Number of bedrooms Garbage Grinder Lot Size <br />,...-0-- <br /> • Are-P--.5 <br />... Private ig <br />Clay Loam 0 <br />.--.; • ..„ <br />Distance ,•to nearist:,-Well <br />,./7 <br />LEACHING LINE [ ] No. of Lines . .Z. - Length of each line <br />s...-,..1 ,.. i-c. . <br />'D' Box-7...•1 .. i._,.._ Type Filter Material <br />Distance to nearest: Well <br /> <br />t-i-.4 <br />Found: ation Property Line <br />SEEPAGE PIT [ ] Deptlz-is4 4,Dkarnetpr Nurnber Rock Filled Yes 0 No 0 ----- <br />rl - <br />Water Tablt Depth ' Rock Size <br />--1771 sit. i <br />1 FoundStion ! <br /> <br />i <br />Prop. Line <br />REPAIR/ADDITION'Trey. Sanitation Permit # i I Date •.'_'" <br /> <br />i <br />-4z:.• ------- --) <br />. . ,,i• , s -N‘ 61." <br />Septic Tank--(S t pecify Riquirements) -- 4._ 46i,Aci. <br />: <br /> i r <br />I 1 . • •0..A.,4c..4...z. <br /> <br />Disposal _fig (Specify .Requirements) ,. <br />.'s .., . ,i i •,. 4124-4 ""1-3. - N 7 i • . <br />1. <br />A....tx...e.a.2._ <br /> <br />AN (Draw existing and required addition on reverse side) <br />I hereby certify' that 1-1h±Sve prepared this application and that the work will be done •in accordance with San Joaquin ...-,or _ <br />, <br />.,u,-;--- <br />County ... <br />Ordinances, Sic& Laws, anefirtiles-and.legulations of the San Joaquin Local Health District. Home owner or !icon- <br />."... i .. st. ..--, ,.I.. —... <br />sed agents Sig e certi fies,The folio g: ):X <br />"I certify /thFt flrforn;ance of ork for,which this ermit is issued, I shall not employ any person in such manner <br />as to bec t to Work pens tlar,t_laws of alifornia." <br />, <br />Permit No: 621 <br />Date Issued <br />Application is hereby made to the San Joaquin Local Health District for <br />described. This application is made inplinè vh Cont i," Ordina <br />JOB ADDRESS/L TION <br />Owner's Name <br />Address <br />Contractor's Name <br />Installation will serve: <br />Water Supply: Public System and name <br />Character of soil to a depth of 3 feet: Sand '0 Silt 0 Clay 0 PecifE--**Sandy Loam <br />Hcirdpan fi Adobe JAC Fill /vtaterial If yes, type <br />(Plot plan, showing size of lot, location of system in <br />NEW INSTALLATION: (No septic tank or seepage pit <br />PACKAGE TREATMENT [ ] SEPTIC TANK [ I <br />Capacit.,k J.,/ Type <br />relation to wells, buildings, etc. must be placed on reverse side.) <br />permitted if public sewer is available within 200 feet,) <br /> <br />Size liquid Depth <br /> <br /> Material No. Compartments •-. Nk <br /> Foundation Prop. Line <br /> Total Length . <br />Depth Filter Material ti <br />D.istand'e/to"nearest: Well <br />. • - .......................