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FOR OFFICE USE: <br /> APPLICATION ICOR SANITATION PERMIT / <br /> ......---•..... .......................................: Permit No. 7S- to ys <br /> (Complete In Triplicate) .... <br /> Date Issued <br /> This Permit Expires I Year from Date Issued "' <br /> Application is hereby made to the San Jodquin'Local Health istrlct"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/LOCATIO ..ClL <br /> _.............. . ....._._..._..........--..._..._... CENSUS TRACT .......................... <br /> -���� <br /> Owner's Name .._._.... . _ ._ .. _.F.. ------- .......... ... .................................................. ..---... hone . .------Wh ------- <br /> ------ -- <br /> f <br /> Address ................. ...... . ...�el�.Q,,....- ..city <br /> Contractor's Name _ -- ------ -••---• -- -• .. <br /> .. ._ ... $------... .................License *9' .J _y....... Phone .7_' 6.5o.-..'�6D•- ?------ <br /> Installation will serve: I Residence KApartment House Commercial f7raller Court 0 <br /> Motel ❑Other-•--••-----•................................ i r <br /> Number of livingunits ...__. Number of bedrooms Lot Sim <br /> -•--• ---�-.._Garbage Grinder ...-•-_-..._ 160...X..zfS.................. <br /> Water Supply: Public System and name ............................................... ........--....................,........................------private <br /> Character of soil to a depthlof 3 feet: Sand 0 Silt 0 Clay Q Peat Q Sandy Loam.❑ Clay Loam <br /> Hardpan�(J Adobe�o Fill Material ............if. es e <br /> (Plot plan, showing size of lot, location of systerri„In,relation to wells, buildings, etc. Aust be placed an reverse aide.) <br /> i • ''tom LC(�l <br /> INSTALLATION. (No septic tank or seepage)it perrIbitted3f.public sewer is available within 240 feet,) <br /> PACKAGE <br /> W IMSTA [�c <br /> TREATMENT P<LSWIC TANK �S e��...?��K- �$�r f Liquid depth . 7; �r <br /> apacity`� __..--•- Type 4, '-•----#Materlal.�� Mfr-- - -- No. Compartments .1.................. <br /> Distance to nearest: Well 4 Kk3A'y t. {*# i a � ..... ..i�................ <br /> LEACHING LINE [� No. oflength of�each line-...... .R .... F Total Length -_ &`................ <br /> o : t fix a� „ <br /> IaaBo ► �-`...... T Ater: teriair--..... �... <br /> Yt?p# a_ Depth Filter Material ....`__ <br /> ft ` , ' , <br /> .- <br /> tance.to nearest: Well .... -..._......€Foundation -----G.�. 1.`.....�-__. Property !#ne �?� `�` <br /> SEEPAGE PIT e`Dept i ..rz .�...._. Diameter .���_,.....�Nu tuber __.....j7_ _ 1r Filled Ye � o <br /> ; .. Rock s N . <br /> Water Table Depth `I <br /> #p ----------5 �..............hock Size _ . ' Mk:'I <br /> Distance to nearest: Well .....•-----: --•d.--.... .\Foundation) ._.1 G...... .... Prop. Lina ......................(P . <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ___.........._......r_-.- --...... Date ______-•.. ...... .............} <br /> Septic Tank (Specify Requirements) ......... ... ........................x 3 <br /> . ................ ...•--•----•-•--...-----.......---•---._..-------------- <br /> Disposal Field (Specify Requirements) ----------------- I <br /> --------------------------- ..--- -..- <br /> (Dra%K,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 San Joaquin <br /> County Ordinances,-State Laws, ands.Rules and Regulations of the San Joaquin local Health:District. Home owner or Ilcen- <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 -- -----• -!-` ! `Owner <br /> /� �pt.� <br /> I -. ... - i--`y . <br /> BY .............. '[J t - - - - Title _....��.._ ........... ----_--------------------- .......... <br /> (If of than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .......... _E. .r .................... DATE <br /> BUILDING PERMIT ISSUED ------ •------------------_----•- ---------------------------------------DATE ----- --•-•--•----. ......... <br /> ADDITIONAL COMMENTS ..............•-----.._.._-- <br /> ------------ --------------------------------....................................-----_.-------------. --------------------------------------------- -------- ----- <br /> - - ............... <br /> -------------•-•- ---------------.......................... ------------- ------ � <br /> ,.�..._. <br /> -- - ------- <br /> Final Inspection by: - -------•-•-.... ....... ...... ......•• --- ..------------._Date .... -.__ ._ .__: . ..---•---- <br /> EH 13 2h 1-68 lkv. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> i <br />