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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> I� <br /> PTriplicate) Permit IN <br /> .!!-:�`�.?.�1111-••---•�E�/��-:..:.. _ No <br /> Co ,���..-.�. ... ..nt lete In <br /> .......................... Date ls'suecl ll..t �Al <br /> lo <br /> TMs Permit Expires 1 Year From Date Issued I ! <br /> I� f <br /> Application is hereby evade;ta the San Joaquin local Health District for a permit to construct and install-I the work herein <br /> described. This application Ii made in compliance Apith County Ordinance No. 549 and existing Rules and Regulations, <br /> / pg ...............................CENSUS TRACT .......................... <br /> JOB ADDRESS/LOCAT N ':. ..7.. �D.f..................•1 - <br /> •�........ <br /> Owner's Name . '............ec? ;. ........ ...../. ..................... .......... ... Phone 1111. <br /> Address .y� . ............................................City. .... ....... .... .........-... ... .... <br /> N License# �� Phone :?:_��� 1 <br /> .. 1111 <br /> ..................1111 :. <br /> Contractor's Name --•- - . -...- . _. � ii <br /> Installation will serve: i !Rssidente Apartment House❑ Commercial[]Trailer Court 0 IIs <br /> Motel ❑Other............................................ IG <br /> Number of living units:_- -- Number of bedrooms ......Garbage Grinder ............ Lot Size _ • ............... <br /> Water Supply,.Public System•and name -----------•--•-----------------•--------__.---------....................................... lay.. .il..Pri+rate,� <br /> Character of soil to a depth ,and <br /> 3 feet: Sand® Slit❑ Clay 0 Peat❑ Sandy Loam❑ Clay loam ❑ <br /> Hardpan❑ Adobe Fill Material ............If yes.type............... !......... <br /> i � . <br /> iPlot plan, showing size of i tot, location of system in relation to wells, buildings, etc. must be piaced�l on reverse side.) <br /> NEW INSTALLATIONS (No�septic lank or seepage pit permitted if public sewer is available within 200 f eetJ <br /> PACKAGE TREATMENT { ] SEPTIC TANK - ... '....... No. Compartments .+. <br /> Siie- � .... q P <br /> ... ... <br /> �Capac" -,� ® ... TYPe - . • Material. 1111. <br /> �I ell .....................Foundation .,f,�. .......... rop.lLine .,�.. . <br /> • Distance to nearest; W <br /> _EACHING LINE Nop of Lines ... - .Length of each line..., ..�..... •• Total Length ..Z ••••••••- <br /> 'DSII Box ..v.. r'C•C Type Filter Material Sl.. Depth Filter Material r .. �� .............. <br /> Distance to nearest: W@II .....� .� _ . t. Foundation r, .............. Property line ................ <br /> e; <br /> SEEPAGE PIT [ De'Ipth 1111 .1.... Diameter ..��._..•.. Number ....... 1111... Rock Filled Yas No, <br /> �r Waiter Table Depth _-.// ..................................Rock Size .2.k. • ............ , <br /> Distance to nearest, Well .,� -_-•.......................Foundation . e� ....... Prop.iLine ...! =_-. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........................................ Date ......................... <br /> .........) <br /> Septic Tank (Specify Requirements) " ..................................... 1-..111...................................................... i.. ........ ................ <br /> Disoosal Field (Specify l equirements) ...............1111....---•-•---...•----....----•--•--••••............................_._........... .........._......-•-----...... <br /> p i <br /> ..: .......... <br /> � .... :._ ... �:: .. ........................ �. ....._....................__. <br /> -••-• 111.1 -•--- <br /> --... <br /> aw existing and <br /> on on <br /> rse <br /> I herebycern that I have�l prepared rthls application and required <br /> the gwork will bedoneIn accerdanuk with San Joaquin <br /> f?1 <br /> County Ordinances, State flaws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lice". <br /> sod agents signature certiffil 0 the following: I! <br /> i "1 certify that In the perFo"nee of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to be bject to W1. man' Compensation laws of California." I! <br /> � /! . Owner <br /> grlec� y . .......:.......__... <br /> /wned <br /> r ......... - --- ..... title .CF`s/•••:••• . ...........�I. ................. <br /> By -- h• <br /> (if other than 1. <br /> FOR fOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED $BY ...1111 DATE <br /> .. 1111. .. ... ...............•--•........-................................ <br /> BUILDING PERMIT ISSUED;.....-..... ................................................................................. <br /> ..DATE>......-...!h......--•------••.............. <br /> ADDITIONAL COMM 5 ... <br /> --------------- ... ................. <br /> .. ......................................... ... ....-.. ........ ;'�........ ... .... ... <br /> f Ii <br /> ............ ........ 1111.- --------.-..... .. ------...-.....�... .;-.._:...'..r11-... 3 ......... .- <br /> i <br /> ......-- ... ......... .....1111. <br /> .... -- <br /> Finol Inspection by iM- .. ......................... ....:................. ..'4...--........-:..............Date . <br /> ��..!`... .-� 1111-1111.. . <br /> E" 13 2!t 1-68 &v., SAN JOAQUIN. LOCAL HEALTH DISTRICT i� 8/7h 3MC <br /> r — - II Q/ <br />