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FOR OFFICE USE: <br /> u APPLICATION FOR SANITATION PERMIT /� <br /> (Complete in Triplicate) <br /> Permit No. J... . <br />:....... .................... ....�_/,� "'v <br /> This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ........ _.. �` _..... .... /LAO ' ............ CENSUS BRACT ..............:...... <br /> ..... <br /> OOwner's Name .t.�e - �rG �i ._ ••-�......=.............. ...F rPkone:-..._ ��� <br /> ' <br /> si 4CAddr ' S. itGk_ .. :.......:..:. <br /> Canteactor.'s Name ;ld►-'i ce---- .._ - Licen`s'e'# <br /> Installation-will serve: ` -Residence-j -Apartment Ho' <br /> Use❑ Comrrtercial [] raiferCpurt: 4 <br /> i �kr <br /> . Motel M. Other :........... <br /> Number of living units:. j.... •Number.of;bedrooms .. ._..Garbage• Grinder . . Lat Size &)Q. lrr ...•,._ ... <br /> # ; <br /> Water,Su 1 S <br /> pp y Public ystem and name' .. Private <br /> Character of soil to a depth'of 3 feet. Sand 0, Silt❑ Clay ❑ Peat[] Sandy loam 0 Clay Loam � <br /> I Hardpan ❑ Adobe ❑ Fill Material Ifyes„type <br /> {Pilot p.Ian,,-shawrng size of, lot, location..of system rn�.relation.,to wells buildings,.etc. ;must,.be..placedF on 'reverse..:side.) <br /> NEW INSTALLATION• (N�septic tank or seepage'pit permitted 5#f public sewer1S available within 260afget,) <br /> PACKAGE TREi4TMENT. j;]:r;SEPTIC TANK f ] Size. Liquid Depth . <br /> ? <br /> Capacity Type _._ Mtenal Na ;Compartments ------- .............. <br /> n <br /> I Distance to nearest 1+Vell :..Foundation Prop line <br /> LEACHING LINE .j [ ] No. of;lines '. length of;eacFi�-line_- _=R ' -.. . dotal lerigtli F <br /> D'; Box ' _ i'ype'F ltee Material : n Depfil,''•Filter Mtiteriol ”' ' <br /> Distance to nearest; Well t .... FoUndotEon <br /> SEEPAGE PIT [.]•_ .Depth Diameter Number_':4:`_i ... - :•Rock. Filled Yes Eli,--No.Q <br /> :.. . . Wdter..Tabl'e..Depth _ _ _. .. Rock:'Size _ r i ' <br /> Distance to nearest ;Well : ' ` i Fou dation .. .. Prope Line .. _ <br /> REPAIR/ADDITION(Prev;. Sanitation'Permit�# _.,e, ... ...__~. _... .. Date .............' . ] i ' <br /> 'Septic Tank (Specify ;Require m <br /> equireents1 -.�/�r�-�►.15r --- . . ....... .. -- ................. <br /> i <br /> Disposal Fieldp(Specify Requirements) ... - � <br /> __ <br /> �.. ..'..,. .......-,l ... • ._. _��. .. .. .e._.. .4......__ . ., .._ .• ___ ............................... <br /> t 1 <br /> l I (Draw excsting.and requicedeaddition on reverse side) ,. _ <br /> I hereby certify that I have prepared th:s,dpplication and chat' ho!work will`be done!in accoMarice Wlh:Son, Joaquin <br /> Cqunty Ordinance's;' State laws, arid-Rules'and;Reguzations of the-Sbn SooC;; local HeolFh;Dlstrlst�Home oiivrier"or iicen- <br /> sed agents signature..certifies the,followirtg:..'.....•.-- • ' .,... �..-...,-r. ;-..,..: .,.'. ., �.......... „;._..., j <br /> "I.certify that in the performance of the work for which this permit is Essued, l shall not employ any person in such manner§ <br /> as'tobeccmesubje' o W kmd''i`• oiripeniation'laws•of California. <br /> Signed _ <br /> . . .z :. ... • . .. . :... _ <br /> By :..�. . c Title 4 <br /> {If other than owner} _. <br /> f : FOR DEPARTMENt USE ONEiYS : <br /> APPLICATION ACCEPTED�. npll <br /> B.Y f._ DATE .. <br /> '._ .. <br /> BUILDING PERMIT :ISSUED _ ._:+ ?: :Y �+� f)ATE -�'- c -- ... _. a <br /> ADDITIONAL COMMENTS ... ' s ' ............ i <br /> ...;._ <br /> :_.....:..... - <br /> .C. .-. �. 1 F F• _i... _ _- <br /> Final Inspettiori by: _ 1 ._ .7. . Dpte <br /> .,; <br /> SA'N.,JO.,QUIN'LOi6AL�eHEALTW DISTRICT_.__ <br /> E. H.13 24 1-'68 Rev. 5M __ 7/72324 <br />