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FOR OFFICE OSE: APPLICATION FOR SANITATION--PERMIT <br /> Permit No. -75---------- <br /> .(Complete- <br /> --f`-.(Complete in Triplicate) <br /> _"._ .....".. ..-..... . ."-------- ------------ <br /> Date Issued .................... <br /> This Permit Expires 1 Year From Date Issued <br /> [FApplication is hereby made to the San Joaquin Local Health District for a permit 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 /> It JOB .ADDRESS/LOCATION' _ 1 ."..�r lY/" ".... .---- . - ----` <br /> CEN}US TRACT _."_ <br /> - Z---------------------- ------- ...P one -.f�cj <br /> �. Name ... ------• - -- �:--�- --------� --� <br /> a - .._.- ----- City �.0 <br /> Owners ` <br /> Address `_ <br /> r� <br /> u 1 -�'17.�._,Li.....�.._..C�L�[.��.V"�... --.----�----.... -.License #�/-�i �� � Phone <br /> Contractosr's Name . .. . <br /> Installdfion will serve: -Residence Apartmen#House!❑ Commercial ❑Trailer Court [] <br /> �; i <br /> t ° Motel ❑Other1� <br /> Number lof living units:..../ _. Number of bedrooms ------Garbage Grinder Lat Siz; �, X --- -----------• <br /> Water Sup ply::Public System and name ................ -- ---- --- ------------- ---Private <br /> i <br /> Chariacteri'af soil"too depth of 3 feet: Sand❑ _ Silt ❑ . Clay ❑ Peat ❑' Sandy Loam ❑ Clay Loami❑ <br /> - Hardpan ❑ Adobe Fill Material .._ ...... If Yes, type _..._ . .. ".._.. <br /> (Plod plan, showing size of lot, location of system 'in relation to wells, build'+6gs,f etc, must be placed on reverse side.) <br /> NEW INSTALLAT;ON; (No.septic tank`or seepage-pit permitted if public sewe'tr s available within 200 feetj' <br /> PACKAGEi TREATMENT [ ] SEPTIC TANK Size------------------------'S.. ". :_... .-.._ Liquid Depth -. --.--..._..._..._----•-� <br /> G [' ;._ .. Type ;.-, ty <br /> i Capacity : --...--- Material--..-.... ._ No. Compartments � .--..------------.--.•� <br /> p Y �._...:.._ <br /> 'fstance to_tin.earest:..Well Foundati n . . ...... . ....... Prop. Line, --- <br /> LEAC�HING LIN E � No- of Lines K.. ength of each line .._" . ._ Total Length "-..__-.-.- <br /> - -- - --------- Y1 <br /> 'D' .,jr, Type. Filter M ziterial --------------------Depth Fil er• Material ...... . -J--- <br /> 1 ' Foundation Proper Line -t---- -- ------------- <br /> 'A <br /> 1 t QistOnce to.-J." est, ...... .. Property <br /> L. ..=�z A.._ Rock Filled Yes No <br /> SEEPIAGE hT . ) 4? Depth Diameter <br /> ---- ---------.. Number ...... .. .�,.. ❑ ❑ <br /> WaterTable Depth e <br /> Rock Size <br /> E _ _ <br /> Distance o nearest: Well .. ----------------------------_--Founds - Prop: Line..---- -•-----•-•--- <br /> REPr41R/A p1Tl N:(�rev. Sanitation Permit# .----- _..._.................------ Date _-._-- ---"11-------------• --.} <br /> Septic ?Onk peci#y Requirements) . . ....... - ................... =- .- _._._.. <br /> Di polo fie d' (Specify .Requirements) ......" -_---- - <br /> z. <br /> ---- --- I <br /> 1 <br /> r. <br /> 'Draw existing and required addition on reverse sie} <br /> I he.eby c rtify that I have.prepared this application and that the work will be d�ne in accordance with SaRrJoaquln <br /> f <br /> Gouty Or irLatei,'tS�tate`lav�is, and Rules and.Regulations of the San Joaquin LoebYHealih District, Homs owner or licen- <br /> k sed gents signature [grtif�,'ses�he�fallowing. <br /> "I c ify t at in.the.perfo m nce of the work for which this permit is issued, { shal,l..,not employ any person i6 such manner <br /> as to become subjett t rkm 's Co ensation laws of California." <br /> /f <br /> Sign d/ .....� - ;,,rl-c ._...------- ------ weer <br /> ' <br /> By , .. ......... - ---- - - Title <br /> f {if other than owner) <br /> FOR DEPARTMENT USE ONLY _� I <br /> � APPLI'CA 1 N ACCEPTED BY E. . �•. . .. .... DATE . . .� <br /> 'PERM,IISSUED -_ ...DATE - , <br /> .. -----. <br /> BUIL 1NG <br /> AD TIONAL COMMENTS . ----- -------------------- ------- .. <br /> - t ._.-__ w_.__r _ - _ - .............. <br /> "_" <br /> Fincif Deaf ....b. "... - - <br />