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� ��� ����� ' <br /> APPLICATION Permit No. <br /> � <br /> �^ `�_�� (Complete UmT6plicate) <br /> Date Issued <br /> Year From Date issuedApplication is hereby made to the San Joaquin <br /> - ' 6 install +�e work herein ' <br /> Local Health District for k to construct on <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations-. <br /> JOB ADDRESSAOCATION -------- -I-eZ-------------------CENSUS TRACT -------------- ----------- <br /> Contractor's Name -------- r1ppoe,M_ _%F�f7-------------------------w-----------License Phon4��� <br /> Installation will serve: Residence J�f Apartment House-[] Commercial E]Trailer_Court C] <br /> Number of living units:--- Number of bedrooms ---,"',------Garbage Grinder Lot Size ------------ <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay Peat El Sandy Loam ,0 Clay-Loam)od <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on. reverse side.) <br /> NEW INSTALLATION: (No septic tcink or seepage pit p ermitted if public sewer is available within 200 feet,) <br /> i Copocity ~-'---_^ Type _-'_'_-- 8atariaL.—'-,—.- No. Compartments <br /> --------- <br /> Distance ----------------------- <br /> LEACHING <br /> �o neomo* \�eU -.--_-''__----Fnundo�nn -------.. 9rmp Lh�� ---'--�'.--' <br /> LE/uCH|NGLUNE [ ] No. of Unoo ----- --------------- -- Length of each Une----.i----- Total Length ----------------- .r_-' <br />' . <br /> 'D' Box,'--. Type Filter Material --------------------Depth Filter Material --------------------------------. � <br /> Distance to nearest: Well -------- Foundation ------------------------ Property Line, <br />/ ------------------------ <br /> SEEPAGE PIT [ ] Depth -^-'--- Diameter --'_'— Number ---'—.--.- R6�k RU�6 ���� [] �p <br />' ---------- ^ ��c� S�e <br /> Water Table Depth _�-.—._�_-_-_----'- -_—_--_'_ , <br /> ` <br /> Foundation ._, <br /> ----. <br /> . R <br /> np. Line ' <br /> Di�onco to nearest: Well --__---_'-�'- <br /> (Prev. Sanitation # . . Dute _ . . _ _] <br /> SeptiTank <br /> To � �p�ify ���mm��) <br /> ' Dispoao| Field (Specify Requirements) <br /> -..0�/V--' <br /> V--------_---- <br /> ' <br /> ", '° --.-_--.--'------.--.-_.-_--._.----.-------_.-- <br /> -�-----'—'—'---'—'-- ----------------------------------------------- _'—_—.--_______.__--_- <br /> (Dmweximingond required additiononreverse side) <br /> . <br /> | hereby certify that l have prepared this application and that the work will be done in mm«omdamwe with Son Joaquin <br /> ' <br /> County Ordinances, State 1m°vs. and Rules and Regulations of the San Joaquin Local Health 0imtelct' Hoxwm wvpnmr or UU«an- <br /> oe8 agents signature certifies the following: <br /> ' \ <br /> ' <br /> ' | certify that in the performance of the work for which this permit is issued, I shall not employ any person ;n such manner \ <br /> | as to become subjectWorkman's � H Xavm of California." <br /> (I f�ot an owner FOR DEPARTMENT USE ONLY <br /> --.-_ DATE _AAPPLICATION ACCEPTED BY <br /> DATE _.____ <br /> BU|LD|NS PERMIT |SSUED ---__—.----'—_'—_---''-'-----'—' -----'-- <br /> '-- - —' <br /> / --'---.--'-----_---._---'--------'_---_------.—'_---_.--------- <br /> ------ <br /> ------------------------------ ---------------------------------------------- ------- --------------- - ------- -------------- --- <br /> .—'_--'_--'---._-'-__'-_--� � <br /> --'-------'—'---' -DoYe ^ / /�'�� ~'/ ''��—'- <br /> Rno| |nspoc�on6y .—.----««,��..�*�.��.'���---'---'_'--------'--- - —' <br /> / 5AN ]DAQU|N LOCAL HEALTH DISTRICT ~ <br /> E. H. 9 1''68 Rev. 5M, <br />