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Owner's Name <br />Address Zc 2-e), <br />2t,t <br />011/2 RTMENT USE - ONLY <br />Permit No. }41. 4ç/ <br />Date issued 6../..516f.... <br />FOR OFFICE USE: <br /> <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br /> <br />This Permit Expires I Year From Date Issued <br /> <br />pplication 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 and existing Rules and Regulations: <br />JOB ADDRESS/LOCATION ./2_{ 'ND / f-A9 / 13e/../i .e:W <br />Contractor's Name <br /> <br />License # 2!---CY/7..6) Phone <br /> <br />Installation will serve: Residence Apartment Housefp Commercial EjTrailer Court <br />, Motel 0 Other <br />Number of living units: / Nm-ber of bedrooms Garbage Grinder Lot Size <br />Water Supply: Public System and name PrivateX ./ <br />Character of soil to a depth of 3 feet: Sand 'D Siltfl Clay El PeatJ Sandy Loam El Clay Loam t• <br />7.7.:Hardpanyks( E] Adobe Fill Material <br />fl If yes, type <br />iPlot plan, <br />NEW INSTALLATION: <br />PACKAGE TREATMENT <br />Distance to nearest: Well <br />No. of Lines <br />'D Box Type;Filter <br />Distance to nearest: Welt <br />Rock Size <br />)Distance to nearest: Well <br />REPAIR/ADDITION (Prey. •SlariitatiOriPihit# Date 1 <br />:-L. <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) <br />j, <br />,(Draw existing and re-quired addition on reverse side".) <br />1 hereby certify that I have prepared this application and that the work will 14 done in accordance with San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Lelical Health District. Home owner or licen- <br />sed agents signature certifies the following: I <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 bec ii5e sut,ject to W rkm .r <br />Signed <br />Compensation,rs' aws of California." <br />_.e-4, . ___ c.,..L.F. <br />P- <br /> , ....... Owner <br />By / - I Title <br />(If other tha owner) <br />APPLICATION ACCEPTED BY DATE <br />BUILDING PERMIT ISSUED DATE <br />-)DITIONAL COMMENTS <br />Final Inspection by: <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />• F. H. 9 1 - '6E1 Rev 5M <br />CENSUS TRACT <br /> Phone <br />El <br />LEACHING LINE <br />SEEPAGE PIT <br />Water Table Depth /17J r <br />62 e) Foundation Properly Line <br />Depth Diameter Numbe7 Rock Filled Yes t2/- No 0, <br />)4.73 <br /> Foundation ./ Prop. Line )241"4" <br />—e <br /> <br />Date <br /> <br />Sq <br />showing size of lotriocation dOystem in relation to wells, buildings, etc. must be placed on reverse side.) )% <br />(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (11 <br />[J SEPTIC TANK Size <br />I . <br />Size -V /2aX's-/ Liquid Depth <br />Capacity ./t7 A'. Material (-e--- No. Compartments r>2.... <br />Foundation /O Prop. Line S t Ae.f;-c./ L , <br />Length of each line.&0 —lel 0.1 Total Length , tf)C) ' <br />Material .S-;'&52)er.k.'..Depth Filter Material /8 '