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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .-------------- <br /> �• (Complete in Triplicate) Permit No. .. .................. <br />............. ....................... Date Issued <br /> ................ • .......... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described: This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ': : � �' �" ....... ..............CENSUS TRACT ... <br /> Owner's Name ......_._ ,r»a. r� .._.:Phone''?�G; . <br /> ......... .... ......•. --- x <br /> Address e r ..--- . City ,A4`04'4AZ . �1... ........:. ...:......._. <br /> .. <br /> Contractor's Name •- i ¢- , r.' ,* ............. ::..License # Phone .. <br /> IYifi#lgfl'8'11"Will"S'ul' : sidence ® Apartment House t] Commercial❑Trailer Court 0 <br /> Motel ❑Other ...................... ..........:..... <br /> Number of living units;---------- mber of bedrooms --------Garbage Grinder ............ Lot Size .... .................. ................. <br /> Water Supply: Public System and ame ................................. ----------------------------------------------------- ------------Priv e r <br /> Character of soil to a depth of 3 f t: Sand❑ Silt Clay ❑ at❑ S*67jd�CgFrk. 6 W lay Loam ❑ <br /> "` larei'p�pi '❑ o"M Jill�lA ria ------- If s ...................... r V <br /> ova. qQ� <br /> (Plot plan, showing size of lot, in latio'n fo w Is, bu dings, etc. must be placed on Je , ide.)` <br /> NEW INSTALLATION: {No septi tank or seepage it mi e , f public s er is available within 200 feet,y <br /> PACKAGE TREATMENT [ ] SE IC TANK ] Si ' .......... ........ Liquid DepthdF <br /> _.Capacity liG.__.... Types a al �lo. Compartments :........ <br /> Distance o ,nearest: Well ........... .....F c;Qm7/04_1.._._. Prop. Line ...... <br /> LEACHING LINE «nes ------- _ � ngth e■ .r v <br /> .. . .... Total Le'n.gth qQ T ....-..- <br /> . <br /> 146epth a!:" Fi�ter MaterSox . -------- Type Filter erial * <br /> .. <br /> stance to nearest: Well .�r.:' . FBenda ion '1✓' Property Line S f_.:......_. <br /> [ pth�Y_-a)0j0 Diameter er ----------•----------------- Rock .Filled Yeel I No ❑ <br /> a �. ., .... t t <br /> ater Table Depth --------- �r-....._t„_ Rock Size ---- <br /> stance to nearest: Well ..................... °__ . oundation ..................... Prop. Line .. <br /> REPAIR/ADDITION{Prey. nitation Permit# X.... Date 1 <br /> SepticTank (Specify Requireme s) ------------------------------ ..,. ...................................................•..............._.. .....' --- -------- <br /> Disposal Field (Specify Requir encs) .................I....... ..........•.............................................I........ ......•• •-• <br /> ----------------------------------- -----------­---------------- -_-•-------------------------..............---------------------- ................. <br /> ............................... .-Draw existing and requ"red ad ...................................... ....-•----------•-----------. ............ <br /> e -- <br /> tion on reverse side) ' <br /> I hereby certify that I have preps ed this application air 4hat th wdfk will be done in accordance with So Joaquin <br /> County Ordinances, State Laws, a d Rules 'and Regulations of the anw?oaquin Local health District. Home owni r or licen- <br /> sed agents signature certifies the f lowing: <br /> "I certify that in the performance f the work for which this per it sr�:ssued, i shall not employ any person ins h manner <br /> as to become subject to Workman' Compensation laws of California." <br /> Signed ------------------------------•-• .....,_._ ....................................... .............. Owner <br /> B ----------••--_---........................... . Title ............._._._. .............. --- <br /> (lf other than owner) <br /> FO kP MENT SE ONLY <br /> APPLICATION ACCEPTED BY 5... ...................................... . DATE : `"1/.. . -- •.... <br /> BUILDING PERMIT ISSUED ------.....4......... ........ . s -..._... = V ....._.... ---••----..... <br /> ADDITIONAL COMME TS r ... . .... :ams-fie.....: � 4+�e..._;� <br /> J <br /> I ........--- <br /> Jorw <br /> .............................•----- ..... ............................-•--•-..... •--- <br /> ...-•----•................ .. . ...... <br /> .Date- Final Inspection by: ....:.... . .. .... --c-= ---._ �=_=_--•--...::...:,..-,------....._....-.--•--------.._.__.... •---•._..----••-- <br /> F� SAN JOAQUIN LOCAL: HEALTH DISTRICT <br /> '�`..�'.. 13. 24, 7/723 M <br />