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. � <br /> FOR OFFICE --- APPLICATION FOR SANITATION PERMIT � <br /> - PennkN� <br /> N�m�p��e�m ��p��«em� � —' <br /> -� � <br /> This Permit Expires 1 Year From ���w 'D <br /> ate � <br /> , <br /> Application <br /> per* <br /> hereby made +othe San Joaquin Local Health District for pit +o construct and install the work herein <br /> described. application is made in compliance with County OrdinanceN 549 and existing Rules and Regulations: ' <br /> /� � �� <br /> JOB ADDRESS/LOCATIONTRACT --.-----'_-' <br /> Owner's Name - <br /> Phone <br /> Cbnondo,'xNome,�;��fAa"— .---.--.License n�����/��~�./--- Phone -J <br /> Installation will serve: �� <br /> Rnsk�a�ce Apartment Houmsf� Commo,do|T-ITro|ler Court �E] <br /> Motel F-1Other -------------------------------------------- <br /> / <br /> Number of living unity—�--. Number ofbedrooms ------------Gor6oueGrinder ------------ Lo �8 --` <br /> � za _.—.---_._—_—.- � <br /> / <br /> VVofe, Supply: Public System and name ------------------------------------------- --------------------------------------------------------------------Private <br /> Character of soil toodepth of3feet: San6'E] Silt 0 Clay E] Peat E] Sandy Loam E] Clay Loam 0 ' <br /> Hon6pon [] Adobe[] Fill Material -.- ---- If yes, type ---- —'_--.—_ <br /> (Phot plan, showing ,be of lot, location of system in relation to vvo|s, buildings, etc. must be o|oco6 on reverse side.) | <br /> NEW INSTALLATION: (No septic tank o, seepage pit permitted if public sewer is available within 200 faet> � <br /> ,�_ / <br /> PACKAGE SEPTIC TANKX, Sizn.e _ .�-_,-`_- <br /> � <br /> � � � � x � c�� <br /> Capacity ����V—_' Typn ���.�~--- ��u�erio No. Compartments .. -_-.-- > <br /> Dio*ono* /o nearest: Well ------------------------------------Foundation — --------- Prop. Lina ��'-------------- <br /> LEACHING LINE <br /> . -_'�`LEACH|NGUNE [ ] <br /> No. <br /> No. of Lines -----^)---------------- Length of each — � —.. Total Lenoth��'.. --------------- <br /> - <br /> -_-^----''' <br /> -.. ---- ;L <br /> 'D' �/ ' Typo Rke, koh»ho| '� - — -- p/h � �Kor '-- | ----------------------- <br /> Distance <br /> —' ' � ~w <br /> j� <br /> / <br /> ff <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 San-Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of t6e°m=r& for which this permit is |^owe6, V s6myU not employ any person in such manner ` <br /> as to become subject to Workman's Compensation laws of California." <br /> | <br /> 8Q —' - Owner � <br /> By <br /> ' T�e ---------------------.—_— ' <br /> (|f othorth8n ' <br /> ~_~.' <br /> FOR DEPARTMENT USE ONLY { <br /> ~' ' ^'C"''=` "~``' '^" BY --------`=`"~~'�~"�==~------------------------------------------------- ------------------ ""'E -- --- -�=---'- i <br /> BU|LD|NG PERMIT ISSUED ------- --------------------------------------------------------------------------------------------------DATE ---- ----.—.---__' <br /> AD0TlONALCOMMENTS --------------------------------------------------------------- -------------------------------------------------------------------------------------- --------- <br /> -------------------------------- -------------------------- ------- -------------------------------------------------------------- ------------------------------------------------------------------- <br /> ------------- ------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- --_--'_- <br /> ��������'����� �������������'������'���� �'���'^�'' <br /> Rnpi|nspstion6y. —.---.- -42��xe—--------------------------------------------------------------------Date ---------- <br /> SAN J0AQU(N LOCAL HEALTH DISTRICT <br /> ~ <br /> E. H. 9 l''68Rev. 5M- <br /> ' ---- <br />