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AOR OFFICEUSE- 1. APPLICATION FOR SANITATION PERMIT
<br />_...._. a.._.. ------ ----- Permit
<br /> (Complete in Triplicate)
<br /> .� This Permit Sxpires t Year From Date lsstte+dt -Dote Issued l/:. . is i
<br /> s Appiication'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 corppiiancee with County Ordinance No. 549 and existing Rules and Regulations:
<br /> f J06 "AUpRPSS/LpCATiQhi ! ��, �:.. ,. . ....... ... —CENSUS TRACT . ...........
<br /> Owner's Name Z�''� 11�.n��, .� � ....:. ...............Phone ......-• ., .. 1
<br /> Address ��}} --•.�..;City- ��... ..................... ... :,.......,.
<br /> CorEtractAr's Nome ._.r .Ly� �.... s�` ,:.,Lit ense #�.r5'/.��� .,. .. Phone ........................ ... i
<br /> Installation will serve: Residence Apartment House C3 Commercial.17rallet Court C3
<br /> Motel j
<br /> hl imber of living units:-. meg Garbage t3rinder ............ Lot Size ...........
<br /> ..._. Number of bedrooms ,.C3a►ba �
<br /> Water Supply! Public System and name , .�.. ...........:: ;�: .r... ..,...............
<br /> ' #'rivat�Q �
<br /> Character of sail to a depth of 3 fit= Sood�. $ilt Cloy Peat� .�ody umm a C1gyi oam a �
<br /> HardpanQ Adobe) fill M619flal sr tyR ............
<br /> (Plot plan, showing stze of 'lot, lor..atlon of system '
<br /> �+ " In rPlatlrtrk to wells, buildings, at. must �e ptciced on reverse rEidr, 1
<br /> NEW INSTALLATION; (No septic tank or see.rage pit.permltte�# 1f p!u411c suer Is avOlable withitk 3Qq f®. A Y
<br /> k1clld Depth ` .....":P TREATMENT ' .( SlC TANK SreX ` ;.
<br /> r
<br /> Capacity . , I TyPe ?14I....,. ,- .. 1 + . ottkparimt:rnra ..$em . ,...:.:,
<br /> Plitance. to nearest: Well, .........l oundciilare .,.. a. ..... Prop, una .. .`.t.......
<br /> I fAGFitNG UNE Na. of Lines
<br /> .:.._ .1 .. .r, . toroth of etsch lirib:... ,. !`: .. Total Length . . ' ..:..
<br /> Sox Type )+liter Materla :.. .: pt1t .Filter Material ..:....l..x...`.:.. ... ......
<br /> . Distance to nearest; We[1 .......2.4?.k.. . ...Fougdptlon .......1.t Property Line .....'I. :l........
<br /> r � .t Depth .. ...rl..7... . fir' ... :![�., Number . ,. .���.:. . . .< hackilleccl Ye¢ N9
<br /> T Water Table Depth ............. J,Q.a
<br /> ........ ..hack Sim
<br /> Distance to tteQrest: Well ..r.,r. ,t~s �.�E f...:...€aurt�tion . .(rO.,�': Prop. Line . ..�.�:�.;•.• €
<br /> 01PAIVADRITION(Prev. Sanitatiart permit+ ..:1 i
<br /> Septic 'tank (Specify Roqulrements) ...' ., _ �,�. `.<,,,. ............ . ..... ... . .
<br /> Disposal Field (Specify Requirements) .:.... .......................................... ............ `.":...............+...._........_ .. _. ...............:.
<br /> ._.... ...._......--- ---- .#. ...................... ............ .... . . ........................ . .... ......... ....-.._..... ..... ..
<br /> ' (Draw 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 Son Joaquin }
<br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin local Health,Disirict. Home owner or Iwn-
<br /> sed agents signature certifies the following:
<br /> "I certify that in the performance of the work for which this perinif t: WOW, I I}hal) not employ atky gers cm in such tk"mime;
<br /> as to become subject to Workman's Compensation law* of California."
<br /> Signed ....................................... .. ......... Owner
<br /> By ............................. ` {`'>�°?-� �..1 _ Title � �,1. .------...........................
<br /> (if other than owner) G-y
<br /> 1'
<br /> FOR DEPARTMENT LI5ts ONLY
<br /> APPLICATION ACCEPTED BY ................... DA"l9.............�'��'.� ...........
<br /> BUILDING PERMIT ISSUED ...".......................
<br /> ..DATE ..........................
<br /> I
<br /> ADDITIONALCOMMENTS .._...__...•. --- . -------------- ----------------..._..................._.._........_......----._._._........_...-_........__......_I...........,....
<br /> -----------------------•----...-.._..._._._...-------------------•-•------._...---•--.._........._....-----------------.........._............_..._._.._.._.-_..-•-------•------•--..... .--------..:,.._.-- ,
<br /> --------------------•--------------- ------------------------..............................................•----..................... ..
<br /> ..................................... ......... ...
<br /> Final Inspection by: Date ...................... .....
<br /> EH 13 2h 1-68 liA-,v. rj'H SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M
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