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EOR OFF]CE`USE/: APPLICATION.FOR. SANITATION PERMIT U-t1 <br /> Permit No 7- <br /> {C.ompiete`in Tripi_ic4tel" .. <br /> _y Date Issued <br /> This Permit Expires 1.Year From Date laved <br /> Applitat�on is hereby made to the San loocluin Local Health District for o permit to construct and install the work,herein t S <br /> f' <br /> described. This application is made in Compliance .with County CiMinonce No. 549 acid existing Rules and Regulations: <br /> y► <br /> JOB ADDRESSAOCATiON _:.J� - ,- -• � - <br /> . :-"---,--.._.CENSUS TRACT ... .- � <br /> T , Phone / .. <br /> ------ <br /> Own / <br /> or t�(orrte :-c <br /> a Address i� <br /> tv ho <br /> r'� cense # :Z <br /> Gontraciat s Name r ..,..... . <br /> Instotlatics will.serve:: Residence Apartment.House[j,Commercial TraiierCourt <br /> Motel El Other. <br /> 5-Num6er of living units !.: Number of bedrooms .Garbnge Grinder .,.--.--,- Lot Size <br /> �1 lrC� C <br /> _ <br /> Water Supply Public:System and.name _ . .v.............................. <br /> - . r <br /> . P ivate <br /> Character of<soil`to adepth of 3.feete "Sand.0 Silt-[}. Clay L].: peat,0,: Sandy Loam© Clay Loam❑ <br /> ardpdn . :Adobe [r` Fill Materiae _. ...:.If yes,type <br /> -• <br /> (Plotpian ho, tg size of.lot location of system in relation to welfs,.buildings,.etc. must be placed an'reverse side.) <br /> f^ rS <br /> g NEW lHSTALLATION: tNo septic tank:or,seepage pit permitted of {>ublic sewer is ava�Iahle within 2a0#eet;} <br /> I` SEPTIC TANK(].]. :Size...... --• Liquid Depth ............ a <br /> - . PACKAGE 7RFr4TNiEN7 j ] .,_ C <br /> Type ----------- Material. -, No. ompnrEments <br /> � x <br /> _76 <br /> Capacity ...... YP P Li <br /> Distance to.nearest: Well .:. ..... <br /> four dation .. :... Prop. n <br /> 1 <br /> LEACHING J ] No. of Lines: ._..._.-��- Length of each lone .l atQC�".. ...:.. Total Lengtltlth�yG1lJ <br /> D; Box -.�.,:..- Type Filter Material` ..a_:��---.-Depth Filter Material ... <br /> Distance'to nearest: We qG' / .._ Foundofson Property Li _ <br /> O ne r a'?. <br /> "j -___ k Filed Ye <br /> z SEEPAGE.PIT Depth v�si� ;:.. D�amefer Number . . <br /> 1 <br /> .Roc a Q <br /> ....Rock Size .. �_. <br /> n s .N i; <br /> .. <br /> .Water.TAle Depth <br /> ,. ^-: - • Distance to nearest:Well ..,.✓...t1.lJ-............:.•- =s.Foundatio:v ... �, <br /> Prop. Line.:.c.. f� <br /> = .. <br /> Af REi°W DITTO rev.Sanitation Permit# - y Date ---......:.................... .:} <br /> rj#f' --....... <br /> Septic Tank (Specify Requirements) _.... .........., ._ / .... ........ .......-.- _. <br /> rt; <br /> INspasat (Specify Requirements) ._._. <br /> {Draw existing and required addition on reverse side} <br /> y® <br /> I hereby certify that 1 have prepared this application and that the work will. be done to accordance with San Joaquin 4 <br /> County Ordinances,-State laws, and Rules and Regulotions.af the San iodquin Local Hea h District.Harte owner or licfrt- <br /> sed agents signature certifies the following: xi <br /> "I certify that ln.the performance of the work for which this permit is lssued, 1 shall not employ any person in such manner ` <br /> as to become subject to Workman's Compensation..laws of California:" <br /> ..........Owner <br /> Z <br /> BY,- ' `. Title . .. ? tZLlx.t .s' 7:..................... ' <br /> other than owner} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED .BY Py DATE-... 7777............ <br /> BUILDING" PERMIT ISSUED --. --- <br /> :.._- .... ...DATE ..:. s ' <br /> €" <br /> ADDITIONAL COMMENTS - <br /> f f . <br /> 7 <br /> !Z. <br /> ...... :..Date .. ... t ..:. <br /> Final.lnspect*by:,,,. �1..� `.... . �r/ �.... <br /> j . <br /> .� "• ✓� •SAN JOAOUiI�I LpCAI H. AL7F{ .DISTRICT <br /> < E:H.9 P 1-'68 Rev.SM <br /> : • <br />