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' I`& `SANITATION PER <br /> rOFFICE USE: <br /> • APPLICATIONMIT <br /> Permit No. <br /> ---------- ----------- --------------------------- <br /> This Permit Expires Date Issued 7 <br /> -------------------- --------- ­------------------------ 1 Year From Date Issued Zr <br /> is hereby made to the San'Joaquin Local Health Distr'i& for a permit to construct and install the work herein <br /> described. This application'is made incompliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRES:S/LOCATION <br /> -X&--------------------CENSUS TRACT --------------- <br /> Owner's Name ----- - --------- -------------- -------------------Phone A6,;?-_%AFP7 <br /> Address -- ---------------- S: <br /> _4_�------" city <br /> I --------------------------------------------- <br /> Contractor's Name -A <br /> ----------------License -------- Phone -W 7, <br /> V :7?44� ...... <br /> Instailation will serve.. 11 Residence ;R Apartment-House-,F7,1,C-ommercia 1-�Tra i ler-Court-!,G.— <br /> II Motel El Other__:--------------------------------•--------- <br /> Number of living units:__.____.-_ Number of bedrooms ___':V___Garb0 [e Grin c <br /> _Jer ------------ Lot Size ------------ <br /> ----------------------------- <br /> Water Supply. Public Syster� and name -------- <br /> ---------------------�W <br /> --- --•---------------------Private <br /> Char! er of soil to a 7J. <br /> Character depth of 3 feet: Sand [] Slit Clay E] Peat E] Sandy Loam -[I Clay Loam 'C] <br /> Hardpan E] Adobe,E] Fill Material ------------ If yes,type ---------------r-------------- <br /> (PlotJplan, sl`;Io�`wingl size-of lot, locdifi6ihi-of system in' rela 0 <br /> J '414. 11 tiori t '"'wdlli, builclings,-etc.-must be placed on reverse'-side.) <br /> NEW INSTALLATION: No!septic tank or seepage .pit� permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] 1; SEPTIC TANK![ Size------------------- ---------- Liquid Depth ------------ N <br /> Capacity - Type--------------------- Material---------------------- No. Compartments ------±------- <br /> Distance to nearest: W;11- <br /> ------------------------------------Foundation ---------------------- Prop. Line --- ------------ <br /> LEAdHING LINE Ili I --_ x-.. - -- - -1 V <br /> No.:�of Lines --------- --------------- Length of,each line----- Total Length <br /> ----------------------- <br /> V Box ------------ Type Filter Material -------- -------Depth Filter Material -------------------- <br /> .............. ------- <br /> Dista"nce to nearest: Well <br /> a ------------------------- Foundation .--------------------.-- Property Line .--__ _ <br /> SEEPAGE PIT-[ Depth -------------------- Diameter ---------------- Number -- ------------------------ Rock Filled Yes ❑ No <br /> Wate"r-Table-Depth._--------------------------------- <br /> -------- ---Rock Size ---- <br /> ------------:---------- <br /> Distance to nearest; Well ------------------------------•---------Foundation _------------- ---- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------ ------- -------7bate.---------=-:j;-- -------- <br /> Septic Tank (Specify Requi its) lk,--) ----------- .: <br /> yerner .-&--- ------------------------------------------1- <br /> ------- ---- ...... <br /> Disposo Fie[ (Sp ea ------ ....... <br /> �e6ii"Iequi� men 1- i---- - ----- ---- ----- <br /> ------------- <br /> -----------:---------- ----------------------------------------------------:--------------- ----------------------------------- -------------------------------------- <br /> 11 (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, 1i64—eLa' w's,­and Rules and Regulations of the San Joaquin Local'Hii1th-District. Home owner or licen- <br /> sed agents signature certifies.the following: <br /> "I certify that in the performance of the'work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -- ---- ----- - <br /> --- - - ---------------------------------------- Owner <br /> - ---- ----- ------- 4 <br /> By ------- <br /> - ----- -- --- ---- <br /> I of <br /> a <br /> _V <br /> f'ot r an owner) -- ------ ------------------------------ Title ----- ---- -------------------------------------------- <br /> A FOR DEPARTMENT USE ONLY <br /> APPLICATION AC EP: ED,-BY;__..BY,�----77e� S------ - -----------------------------------------------DATE.- <br /> BUILDING PERMIT ISSUED ---" 1 <br /> ADDITIONAL COMMENTS ------------ --------------- ---------------DATE -------- ----------------------------------- <br /> -- -------t---------------------I-------------------------------------------�­------------:------------------------------------------------ <br /> ------------------------------------------ ----;i ­ <br /> - <br /> ------------------------------------------------ --------------- <br /> -------------------------I----------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- ------------ <br /> ------- ----------------------------- <br /> ------------------�t-------------------------------------------------------- ------------ <br /> ----Date ----- <br /> Final Inspection by: ---- - ------------- --------------------------------------------- Da <br /> -.SAN -JOAQUIN LOCAL HEALTH DISTRICT <br /> • <br /> E. H. 9 1-'68 Rev. <br />