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77 <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7�f� 6- • <br /> Permit No. <br /> ............ ..... <br /> . .. ....... .................... . � (Complete in Triplicate) <br /> Date Issued .6�7 j3-- (o <br /> This Permit Expires 1 Year From Date Issued <br /> all the work herein <br /> Application is hereby made to the San complianceacal Health wi h County District <br /> Ordinance permit <br /> and ex sting Rulestand Regulat ons' <br /> described, This application is made <br /> .CENSUS TRACT <br /> .SOB ADDRESS/LOCATION � -. _w •--.F� :_.' '._,_.'..... <br /> �._. - .. .. Phone ' <br /> , <br /> Owner's Name <br /> :. <br /> - -------.. ...._::.: <br /> city'. <br /> Address :... .. / . .. �F'hone --• <br /> '' ..License;# :f - <br /> --- <br /> Contractor's Name :- <br /> Residence <br /> r r r u <br /> Installation will serve: <br /> �/AA" ortr�nentpHouse[j-Comnie sial�❑T oile 'Ca rt ];` <br /> t F they...__.>.._.. .......::r:::: :i_:... <br /> • ,., Motel.❑•O .. -- -- <br /> Numt e <br /> I <br /> Number of living -un.. oars,. - Gorboge..�r,inder - --. <br /> e [o <br /> Lo 5iz private „ ,I <br /> f Water Supply: Public System and name ---- ----.. : : ; <br /> .. .... ...... <br /> Peat 5and Loam Q Clay Loam [ '� <br /> Character'of soil to a depth of 3 feet ,Sand❑ Si It❑ Clay' ❑ e ❑ ., <br /> ....... ...... .... <br /> HaidprEn ❑ Adobe [] Fill Mot ria f yes,:type I V <br /> € r ;,......;:..,... , <br /> _• _ - �— <br /> {1?iot plan,.showing s�xe of loi,.EocatiAr►..,of..sy-Stem .in relation :tu.Vuells;,.bualdirigs, etc must- be .placed� an reverse sided <br /> NEW INSTALLATION (No septic tank ar seepage pit permitted•if•-}?ubjic-sewer 4s ova+Iable;withEn 200,feet,j <br /> - _ Lkquid bepth <br /> PACKAGE TREATMENT: [ ] <br /> SEPTIC TAMC ] Size .... - ; . F. <br /> Cdpaci TYPe ,: . Mbter!al.:: :- --- ;No.`: Compartments <br /> a �' . <br /> { ' Pro Line h <br /> t Distance to nearest:- Well Foundation P i <br /> LEACHING a <br /> f'each Brie 1 otal Length <br /> LINE [ ] <br /> • No of LEnes Lengtl, •.e k, ..• , <br /> { "D box Type rilter'Materia epth <br /> Nldte <br /> i <br /> Fourrdtst�ori .:.! Property iter � ria <br /> :. , .._ . ..'. ; Well <br /> r F <br /> ; Distance �tcr-nearest; <br /> i• - Lin <br /> i Diameter . Rock illed Yep []: No [] f <br /> ` F <br /> r ; <br /> SEEPAGE PIT, [ •] :..Depth ..... . _....e <br /> Iwitiml5e <br /> = Water..Tab1e..Depth __ 5i;:e. .i i <br /> �. :_ <br /> Distance to nearest::Wei! <br /> .. -- ... . Foundation..: 4P• <br /> Line <br /> l ........ .. ... <br /> D <br /> , ate _. <br /> 11t ADDIt10N(Prey. San itdtion';Permit�# .- . <br /> R1PA / z <br /> .., - : <br /> ... __-. . <br /> ;Septic Tank (Specify:Regyireriment'sl _ <br /> €D' 'osol Field (Specify Requirenr ents) <br /> } I <br /> Z a o .t .. ...... <br /> - <br /> i <br /> {Draw existihg and required„oddjtjon.or�.reverse-side] <br /> p... P. San Ja°quln.. <br /> I hereby certify that I have pre ared this a plication and that the work wilt be done in accordance wrth <br /> ....owneror liian' <br /> County Ordinances, State Laws, and Ruies and Regulations of t' <br /> Horne <br /> • lie San Joaquin Local Heat ' �stnct. <br /> sed agents signature certifies the.following:.. :••.• <br /> "1 certify that in the performance of, the work for which chis permit rs issuedr,l shall not employ any Pers <br /> on in such manner <br /> as to liecor++e subject to Workman`s Compensation laws of California.`' <br /> ---- <br /> Oiwner <br /> Signed i .- . .. t <br /> t. :- .:. <br /> •• ife.. <br /> • ..-.... <br /> (If other than owner) <br /> "F <br /> F RaPA <br /> TMENT USE ONLY. <br /> �-_. DATE. : <br /> APPLICATION ACCEPTED BY .--;--[_ `. '; : , <br /> BUILDING PERMIT ISSUED _.:.- DATE - <br /> ADDITIONAL COMMENTS ---------------- <br /> , <br /> l ... - mate / '?-�f <br /> Final Inspection by <br /> SAN JOAQUIN LO(Z6Lr1HEALTH. DISTRICT... <br /> 7/72324 <br /> iI -)i _ .._ <br />