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f 1 s � <br /> xs <br /> FOR OFFICE USE: APPLICATION FOR--SANITATIONPERMIT <br /> N ._. {t omplele in Tripl tate} Permit No �i � � <br /> _• <br /> Da issued �] <br /> This Permit Expiras 1 Year From D61e lssuod <br /> te � <br /> .. ...... . .... <br /> r Application is hereby made to the San Jovquin Local Health District for-a permit.to construct and install.the work herein _ <br /> described This upplication is made in compliance with Couy Ordinance No 549 and existing Rules and Regulators a <br /> CENSUSF TRACT <br /> JOB ADDi2ESSlLOCATION / .- /� •----G�- � y <br /> Phone . <br /> Owners Ndme° :!/' .7. a-�..rT s ' <br /> F . Address ��'=71� City <br /> _..__.._-.:. <br /> l t Contractors Namect._.% ..License# = <br /> Residence A artment House Comrnercral Trailer Court j] <br /> Installation will serve: P <br /> .M - tik s� <br /> r i <br /> Mosel j]Other <br /> 4 <br /> Number of.living units <br /> �._:'Number of bedrooms .. Garbage grinder <br /> Lot Size a <br /> . <br /> 1 Public Sy stem and name <br /> 'Water Supe Y. -'-• � -, c <br /> Character,of soil to o depth�of 3 feet Sand 0 Silt.© Clay, ❑ Peat[� .'Bondy Loam © . 'Clay L00m. <br /> $ Hardpans71 Fill Material : If yes type <br /> #p h� <br /> 3 <br /> {Piot,p[an, showing size of"lot local on of.:systemJ'in relation to wells biiildmgs,:etc must be placed an reverse sida} <br /> I 3 NEW INSTALLATION: (No Septic tank or seepage pit permitted rf public it!'wer is available within 200 feet} , <br /> PACKAGE TREATMENT ( ]„ kPTlCTANK .� Size Uquid Depth- , <br /> t r, <br /> f Material..._ <br /> rapaat), TYPe -- x <br /> No Compartments <br /> 1 Pr p <br /> est. Four dation Distance to":near <br /> '. LEACHING LINE of Lines' I Length of each-line.--:/.ed Total Length <br /> .; <br /> D Box /-. Type Filter Material ......... 'Depth Filter h9atena! --�� <br /> Distance to nearest Well ' / Fovndatron Property Li <br /> CJ ne <br /> SEEPAGE P!T Depths :. Diameter a� Numbe a Q <br /> n <br /> Water Trble Depth _ !L�..:.�:: Rock Size: _. ac <br /> R k Filled Yes <br /> 4 Distance`to nearest: Wel! /-rr-..__ ...:.........::..Foundatiyi� , P ✓ <br /> UQ.._�_. Pro Llna .... <br /> R€PAI DITIONWVrev.Sanitation.Permit# . <br /> Date , . <br /> ' Septic Tank (Specify Requirements) ... •....... <br /> ... <br /> p�spotaL-l`'iaid is Requirements) <br /> ... <br /> . E <br /> 3 <br /> ..:... <br /> (Draw existing and required addition on reverse Side <br /> [ hereby certify that I have.prepared this.opptication and that the work will be done in accordance with San=4oaquln <br /> P County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Heailh District.Hama owner orllcen-y ; <br /> . sed agerits`signature certifies the following: <br /> "I certify that in the prrforrriance of rhe work for which this permit is issued, 1 shall not employ any person M such mvnnor �� <br /> . f <br /> as to become subject to Workman's Compensation laws of California." may, <br /> i Signed .. ... Owner <br /> . $ 7 r tl.G -lir' ............. Tit€e . ?..-..... s �S <br /> t <br /> ' {tf other than ownerl <br /> rd 1 5 i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY Q,t -. .. <br /> DATE ...- _' 7 <br /> 77, <br /> r BUILDING PERMIT ISSUED_-- ._.:..----- : . .-... -. _,-. DATE .... ........... <br /> i ....... ..............................._ ' ......_.-_ <br /> ADDITIONAL COMMENTS .........................•........_.-.:..._ <br /> A ......._-.. <br /> --•-------------------- - <br /> .. <br /> ....................- -...... ...J, .:... .... ..ti <br /> Final Inspection by:............. ....,._.._ ..,lti.. l............. �. 'r..-r ;•� 'J <br /> 'L <br /> v' SAN JOAOifiN LdCAL HEALTH DISTRICT <br /> E.H.9 17'68 Rev.SM , <br />