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FOR OFFICE USE- ATION FOR SANITATION PERMIT <br /> - I, ---------------=------------------------- ---- AI'PL1C Permit No. <br /> (Complete in Triplicate) <br /> -----=---- -------- ------------------------------------ <br /> Date Issued __7711-4e <br /> This Permit Expires i Year From Date issued . <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 complianc`e/with County Ordinance No. 549 and existing Rules and Regulations: '^ <br /> JOB ADDRESS/LOCATION .0-n7 --- ": ------------------------CENSUS TRACT --------- ----------------- <br /> Owner's Name ----��__4� Jy---1-7_AVZ7A5_&_6_��: _ �-------------- <br /> ' • -------------- --Phone ---------------•-------------------- <br /> Address .5---------_--------------City _m 7r r17 -------------- -----=- ...... ------- <br /> Contractor's Name ------PWAoKdZV---►------------------------------------------------=--------License # ---------:-------------- Phone ------• •-'= .......... <br /> ,r f <br /> Installation will serve: Residence,.�Apartment House❑ Commercial:❑Trailer Court IC] <br /> F __ : /ems✓ <br /> Motel ❑Other'- 7Y ___— •_� v <br /> Number-of living units:--- z_- Number of bedrooms'______Garbage Grinder A.&--- Lot'Size .____"_ 9 "- <br /> ,- ._Private_ <br /> Water Supply: Public System and name - ---- _1--•-=-------------------------------- �;-;-� --------- - :----------------;-- ❑ <br /> Cl arac erof soil to a depth'of 3 feet: `Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam.-ECClay Loam [- tC <br /> 1. <br /> Hardpan ❑ Adobe Kl;,,Fill Material.-___-�_,If yes,.type -------------------------- <br /> {Plot plan, showing size.of lot, location of -system in relation_,to wells,. buildings, etc. ;must be ,placed on reverse side:} , <br /> A . <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public,sewer is available within 200 feet,) �' <br /> PACKAGE TREATMENT { ] SEPTIC TANK'[ ]'; Size--------_________ _____'.____._"----__i_--- Liquid Depth .------------­------- <br /> Capacity- r' �TYpe ' Material--------M ---` ---- No. Compartments = <br /> LEACHING LINE No. of Lines ________ Length�'of ea--_:`-�_�_Fqundation ____:=___________ ""_ Prop. Line _____"_____________•.. <br /> Distance;to nearest: Wel! ___-___-=,__ _-__" - <br /> L ] ch line---k = '------------------ Total Length <br /> s <br /> 'D' Box +----------- Type Filter Material --------------------Depth Filter Material ----------------------------------- <br /> Distance'fio°neares#: Well __"_____"_}:__ _____ Foundation "______________________ Property Line. -------------------­- <br /> SEEPAGE PIT [ ] Depth - Number -___. ` .`*-----------______ Rock Filled Yes (] No ❑ . - - <br /> --`----------------- Diameter <br /> ' Water Table Depth ----_------_ .. : ` ' <br /> ----------------------------- ---Rock Size _==------ -:----'-.--------------- <br /> Distance to nearest: Wel! -----------------------------------------Foundation --;3--------------. Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------f_-446,__`: --`----- Date ___�____� <br /> % Septic-Tank•(Specify Requirements) ------14-e�Q_ ----_C�wl..---��rS/1�------------------------------------------------------.. <br /> Cf <br /> Disposal Field. (Specify Requirements) iS�G,f =__ ---- - -- h-L- --- � <br /> �r �'` ';►_ (Draw exisfirig,arid-required addition on reverse sid - -+c✓ <br /> - � _ accordance with San <br /> I hereby certify that I have prepared this application and that the work will be done in actJoaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heaith 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 jest to Workman's Co pensation laws of California." <br /> Signed - !_ ------ Owner <br /> ------ ------ Title ------------------------------------------ - --------------------- <br /> (If'other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> t <br /> APPLICATION=ACCEPTED BY w " -------=-----=---------------=----------------- ------------ DATE --- 7.__ X76.10-,------- _P6_10-,e---------- <br /> BUILDING.PERMIT ISSUED -----------------------------------------------=-----`-- ------------------------------------------------DATE ----------------------------------------- <br /> DDITIONAL COMMENTS ,_ -------- ----- , -- - <br /> ---------- - ---- - :. - . _ : - - - - - -------- <br /> e ------ - `-------------------------------------------------_ --------------- -------------------------------- <br /> ---- ---- -----= = <br /> - ---------- -- <br /> Final Inspection by:'--- :- ': ------------------------------" ------- _- --------=----- ---._Date -.-"-1-7:7��1- ��------------ <br /> 5AN JOAOUIN LOCAL HEALTH' DISTRICT <br /> �'E. H. 9 1-'6$"Rev. 5M <br />