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FOR OFFICE USE. <br /> . APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. ...77..-:. <br /> F <br /> "' This Permit Expires 1 Year From Date Issued Date Issued ._S.-1S__7y <br /> i <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 Na, 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> _ G'r'."�'`. .................... .............CENSUS TRACT <br /> Owner's Name � n _..""-.... <br /> I Address ...................�. Arte - <br /> ..._...._ <br /> .. City <br /> Contractor' ............ ........ <br /> r <br /> Contractor's Name ................. : / .. <br /> .. .. . .----• g— ................License # ���".3.�.3. Phone `�:�.6.`.`�.�.a.�._ <br /> Installation will serve: ResideneeApartment House] Commercial []Trailer Court 0 <br /> Motel (]-Other'.......`.`':.T - <br /> ° ( IN <br /> Number of living units_____________ umber of bedrooms _.��Garba e Grinder .._..-.___-- r <br /> - & 9 Lot Size ...1�0._1r.,1 Z1 <br /> Water Supply: Public System and name .c:-.-- <br /> ^. --.-----•-•r....:::�:.. == �= � � .. yr ate <br /> -•--Pr' <br /> ----- <br /> Character of soil to a depth of 3 feet: Sand[] _ Silt❑ .CIO Peat - < r <br /> Peat Sandy Loam & Loa <br /> ,.a ,f ❑ Y m <br /> Hardpan `^-�' <br /> p Adobe Fill <br /> M, rial ---- If yes,type .( <br /> r t is <br /> (Plot plan, showing size�of lot, location of. system in relation-to wells, buildings, etc. must jbe placed on reverse!sld I <br /> NEW INSTALLATION: (No=sept c tank or`see a e e'j <br /> �,.�p g pit permitted if public sewer is available within 200 feet,) ��'` <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' + <br /> { ] Siae.__....---•.-•- _ Li uid Depth--- q <br /> Capacity .... •-----• Material No. Compartments <br /> kDistanc to o nearest: Well � <br /> � ' Foundation ..... ••---- Prop. Line LEACHING LINE �o. of Lines Lengthline <br /> i <br /> ... 6 � <br /> of each dine.------ .:........... .... Total Length- <br /> r 'r.:.�_ .............. <br /> 'D' Box ...---'--- <br /> ype Filter Material .-.._-_.-Depth Filte5 Mate°rTalro <br /> Distance to nearest Well "" <br /> s Foundation = f Z <br /> ----.. .... • roperty Lin{ . , <br /> SEEPAGE AIT [ I De the ` I ................ <br /> i <br /> ---.��_ A rz_.. Diameter --- t. Number"", <br /> ................... Rack Filled Yes ' No <br /> Water Table Depth <br /> to, <br /> ckr � <br /> '. k rbize -' <br /> --....�::;...:.----.. c ----•- <br /> i Distance to nearest: Well _- <br /> ,t <br /> ----•-..-•.l`••--.:Foundation f --- <br /> REPAIRfADDITION(Prev."Sanitotion Permit �" ---' - <br /> ��� �Prop. Line .... � 1 <br /> ,. ---•- •----.... _y . .�� _. .. Date _ '� '�' �� ...:.,. •)._._. .,�.., �.�:�'' 1 <br /> Septic Tank (Specify Requirements) ..... C _ .- <br /> Disposal Field IS Requirements) .- .......... �—�� <br /> � '7��` 1. ... _ <br /> ------------------- ---------•-- ----•- • -- <br /> r.. <br /> --- .......----------•--••----- -­---------------- _ _ ,. ` <br /> (Draw existing and required addition on reverse side) <br /> .___4 I <br /> I"hereby certify that I have prepared this application and that the work will be tdons in accordance Ltl� San Joaquin <br /> County Ordinances, State Laws, and Mules and Regulations of the San Jopgin�.locnl Health District. I;onfie �w"n or'licen- <br /> sed agents signature certifies the following: <br /> "t certify that in the performance of the work for whicFthis permit is Issued, I shallot employ any person In such <br /> as a become subject'fo•Workman's Comb``nsc tion'la s of California." p manner <br /> Signed ................ <br /> ----- Owner <br /> By .. Title t T'• # <br /> ••. <br /> (If other'th caner) ............. <br /> ! I FOR,-;DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTE <br /> BUILDING PERMIT ISSUED _ _-._: DATE ....s� f <br /> ADDITION ..__. ` <br /> -------------••-----•----- ---- <br /> AL COMMENTS._. ' ............�. _,.. ....DATE <br /> ................................:.-------------------------- <br /> .... <br /> l........ ...... <br /> ! 4 •- - <br /> .....1.----------- <br /> .....................».-----------.----..._---... <br /> Final Inspection by. //` j.._, ..-------• _-..__.. <br /> _Y...W • _.. ....................................... ...._........ . <br /> .....Date . r_ <br /> ti SAN JOAQUIN 'LOCAL HEALTH DISTRICT <br /> E. H._13 24 1-'68 Rev. 5M -, <br />