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FOR OFFICE USE: (""'PLICATION FOR SANITATION PER r y <br /> Permit No. .:.75......a/ <br /> {Complete in Triplicate) <br /> .. _.._.... �--------•.............. . ....-- Date Issued .... —.3, <br /> ..3.-.3-.7.� <br /> This Permit Expires 1 Year From Date Issued <br /> Application 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 /> JOB ADDRESS/LOCATION <br /> eZ ...... .CENSUS TRACT ..- .a-----� - <br /> ...---.... ..�.�11.3....�r.d��J.IY.T ......- ....... _ <br /> Owner's 'Name ... ----- • • ......... ---Phone -.8- -r3 <br /> Address ... -------------------- City . C.. ------.... <br /> ---.License # v+G Phone . :.�fP <br /> Contractor's Name . A. �.... C/.C►� �y .... O` <br /> Installation will serve: Residence 10 Apartmen House❑ Commercial []Trailer Court ❑ <br /> i� <br /> I Motel ❑Other ------- -------------- ----•-- l/ ,� p`� <br /> Number If living units:....!. Number of bedrooms ......Garbage Grinder .:._. Lot Siz�i�-.".------.A.-...... •••• <br /> Water Supply: Public System and name . ...... ..-"----. PIivate 56 <br /> k Charpcterof soil to a depth of 3 feet: Sand❑ Slit[IClay ElPeat❑ Sandy loam EDClay Loaml❑ <br /> Hardpan ❑ Adobe Fill Material ._.. ----- If.yes,type - - <br /> (Plot:pla , showing size of lot, location of system in relation to wells, b'! d' gs, ytc. must be placed on reverse side.) <br /> NEW 1N5 ALLATION: (No septic tonvor seepage pit permitted if public se�+. s d"vailo,ble within 200 feet,)4 <br /> PAC, G .1,TREATMEN [ ] SEPTIC TANK j j Size.-----_---------------- <br /> �• .- . - . .- ..... Liquid Depth ..�...--..------------•-• <br /> v0 <br /> r ! � <br /> Capaciiy . ' Type .. ... Material..... .,. No. Compartments <br /> i 4Y <br /> -------__ <br /> Dt. Well Foundati Prop. L'ne . <br /> i .....:....�j <br /> i Total Length ---- >n <br /> LEA HIN LIN [ ] No. of Lines �._ ength of each line' -........ ... ...... . g �-.._.."."...... .. <br /> { D ox- - Tie (filter teriai "...................Depth Fil r.Material . <br /> Type <br /> a Disti:e 1-to,narest:--Well ..:... ................. Foundation ... .. Property Line. <br /> SEE GE IT J aP Depth Diarnete ---------------- Number s.....-- Rock Filled Ye,� ❑ No [] <br /> I�Ie Water Table-Depth -------------- -------•--------_-------.....Rock Size __.. <br /> Distance to nearest: Well ---- -- ------------------------------ <br /> ..Founds ............. ....._ Prop: Line; <br /> ann ---._. Date -- <br /> REP iR/A D1TI f�l{�rev. S 'niton . Permit# --------. ... ..- .- - -- -- ----•----•------- } <br /> tic nk {e V. i e uirements) _ .. . .... .... .... ..... 3 . <br /> Se Sp <br /> eft <br /> poso Fie IS ec�fy �gUirements) .1�. - G' ._ .: - 1 - ::, <br /> .g.. q h ¢ <br /> ► q _ (Draw existing and required addition on reverse si e) I <br /> I he by c rtify tWl I hove. repared.this application and that the work will bed ie in accordance with so"'Joaquin <br /> Cou ty O inppces,Ntfa.wto s, and Rules and Regulations of the San Joaquin Locbl`,�iealth District. Home owner or [icon- <br /> County <br /> gents signature iertifjeX#ie�following: !{ <br /> • "I c 'fy t at in thesperfo r>ta�rice of the work for which this permit is issued, I shall not employ say person i� such manner <br /> c <br /> t` as to b�rco a subjeet�4n 's Co ensation laws of California." ;! f <br /> rSign d i !�G-s: ........ . ------ -- --------- --- Owner <br /> 3BY ._ ... ... .....:......... . . .....................- - ... ... -......_....---.._...... Title - ..... .. <br /> (if other than owner) J <br /> r-- -..^ r:v FOR DEPARTMENT USE ONLY===___ _ � <br /> t 2 -./4...T.- ........... <br /> L:APP ita. TION ACCEPTED BY <br /> BUIL ING PERMIT ISSUED _. . . ....... ......... - ..DATE ..---.`-------.......-------- <br /> AD TION L COMMENTS .. ?_ .. . . ... -- <br /> ...... __ <br /> } Fina Insp - -- - - a e "... .. ...... .. ....... ... <br /> - - - r .w _ <br /> �' SAN JOAQUIN LOCAL HEALTH DISTRICT <br />