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, �oR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .7 ,- ,r ---------------- __-_ - {Complete in Tri licatel Date Issued ,5-14--V"' =-r (�= • .zv ------------------------------------------ This Permit Expires 1 Year From Date issued -------- ------ - � permit to construct and 'install the work herein 1 Application is hereby made to the tan Joaquin Local Health District fora p - Dance with County Ordinance No. 549 and existing Rules and Regulations. described. This application is made in compliance --- CENSUS TRACT �ij� 1----------------------- / JOB ADDRESS/LOCATION 71-7 -4-�' f t.'+�1� ---- Phone��_--- Owner's Name ----------------- ------ ---- --Rla------ --- city - ------------------------------------------------ -5t'- _5./j -/1 Phone -- ._ t�7�r�-- ------License # ,: ? Contractor's Name ----- ------ -- - - artment House❑ Commercial ❑ Trailer Court l0 Residence�Ap Installation will serve: Motel ❑Other -------------------------------------------- ----- ------ ----------------------------- L t Sze -- --------- --- --- --- -------------------- �Garbdge Grinder ---- - = r private ❑ Number of living units:"-_ _ Number of bedrooms _-__ -_---- ----- -------------------- - Water Supply: Public System and name ----------------- ---- -- '❑Clay 13Peat❑ Sandy Loam Clay Loam:❑ Character of soil to a depth of 3 feet: San d'Ej Silt 11 --- Hardpan ❑ Adobe Fill Material ------ ----- a-yes, , + ` tsz`pr, laced on reverse side.) i buildings, etc. mustibe p (Plot plan, showing size of lot, `location o_f_ s_y_stem:in`relation to wel. s, f �� 1 ;t ermitted if publiF sewers available within 200 feet') I�t� ,d tic tank or seepage p p Liquid Depth _ --- NEW INSTALLATION: [No sep �(" , SEPTIC TANK ize------- '= E zr_... PACKAGE TREATMENT [ ] No. compartments l F Z Type —'---- Material �-- Capacity�------ `a Prop. Line --- ------=----•--- Foundation -- 1- Distance to nearest: Well --------------- Total Length --,46-- ------------------ •. , -� sI f /0-"--- ! No. of Lines _" _- - --(-------- ---- Length o ea line"_-. - LEACHING LINE - Depth Filter Materidl _1- Box --------I--- Type Filter Material --- - f Foundation f Property Line -------- ------ Distance-to n �st: Well ------------------------ Rock Filled Yes No SEEPAGE PIT } Depth'i.---- -J;_. Diameter -_3-(?_----__- Number ----------- _ -> I _ _----Rock 5ize� �f� Water �able Depth .` .�--------------------------- •- r Pro Line .-A----- ----------I Foundation ---'f ` p Distance to nearest.-. Well-=-=- -------------- i i e k~. ----------- Date -------(------------------------ REPAIR/ADDITION(Prev. Sanitation Permiti#------------F-i. _.; '- ----------------------------- --------------- r�------------ -------- Septic Tank [Specify Requirements) ------------- --- Disposal Field [Specify Requirements] _-------- ----------------- c --------------------------------------------- ---------------`--- --- ------- --------------------------------------------- --- ---'- ------ --------- - ' ' ------------------------------ -----_ ------ ----------------------------------- --- - --------- ----------------".--" --� ----------------------- - - (Draw existing and requrred.addition on reverse side) ti I hereby certify that I have prepared this application anc�_jthat the work will be done=in dccordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local He�lth District. Home owner or licen- sed agents signature certifies the following: "I ce o certify that in the performanf the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation•laws of-California:"-� - Signed -------- --------------- -------------------- Owner ------- ---------- Sitle --._ - By ---------- (if oth han owner) j F FOR' ARTMENT USE ONLY kA.h : DATE rr�L:1 zl APPLICATION ACCEPTED BY;_'------ ---- - - f---DATE -- ---------------------------------------- BUILDING PERMIT ISSUED ---1-,--- - ----- ----- ---- ------------------ ADDITIONAL CO ANTS - ---------------------------------'----------------------= ---------- .� _:�4 - -- ----------------------------------------- --------------------------- u--- -------------------------- =----I"-- ---��'---- - ---�----------Date ---- �_- - ---- Final Inspection by: -- "-_ i / J AN JOAQUIN &C4L. F ALTH DIiSTRICT E. H. 9 1-'68 R 5M