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FOR OFFICE USE: <br /> w� APPLICATION FOR SANITATION PERM17 <br /> Contractor'sApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> des,cribed. This application is mcicle� in compliance with County Ordinance *No. 549 and existing Rules and Regulations: <br /> .'__ ----~—'-.—_---~,_,._'°~—.---'--__-License . ,'-~-~.^'^— Phone. +~~.'~�~~.^_—. <br /> Installation will sar/e. ^~ /i6ence�yApo�mnntHnvo,�] Commancio|�]Tro||o, <br /> ` ` <br /> Motel []Other............................................. <br /> Nvm6o, of living units:.../....... Number of 6p6,oumo ....4 ....Go6boge Grinder Lot Size � x « <br /> ....... <br /> VVo+er Supply. Public System and name ''-_�'---'_---_.---_--__-'--..---'—'- �' `—^�—.--.—Pr�ouu�� <br /> - . . <br /> Character ofsoil toodepth of3feet: Sarid 0 Silt E] Clay PeatO SandyLoom' [E OoyLocimO <br /> Hardpan Adobe-[] Fill Material ............ /fyes',t/pe --_-----.—. <br /> (Plot plan, showing size of lot, lo'cation of system in'r6­1cjtion ta wells, buildings,�etc. must be placed on reverse side.) <br /> NEW INSTALLATION! (No sep'tic tank or-see0age pit permitted if,.publ ic.sewer is available within 200 feet,) <br /> 'D' Box:.0-- Typo Filter K400a,io| ....................Depth Filter Mokoho| ....... <br /> Septic Tank (Specify Requirements) ---------- . .... <br /> Disposal Field (Specify Requirements) -_—._ ......................................................................................................................... <br /> -'----------- <br /> ~ <br /> ---'-----'----`--- ..............................................^.................. ---------------------------------------------------------' ........... <br /> - <br /> '(Draw existing and required addition on reverse side) <br /> | hereby certify that I have prepared this application and that the vvn,k will be done in mczw,6mmoe with Son Joaquin <br /> County Ordinances, State Laws, and Rules and RegwKmMmno-pf_tho`Son.Jpaq u|m.Lppmi Health District. Home owner or |icwm` <br /> sed agents signature certifies /6ofo|l�winq: <br /> "I certify that in the perfornpnce of t6ew/o,k for m,6ix6 this permit Is mov*d' / shall not *,np|wy any poo^*n in »wchm*onne, <br /> as to become subject to Workman's,Compensation laws of California." <br /> > <br /> Signed .......... ......... ............ ......... ........................ O <br /> (If other th owner) <br /> ` APPL|CAJ|ON ACCEpTE� BY ^— A................... - D/Q�E —..��`-�- . -_-'_-. <br /> BUILDING PERMIT |S�UED -'���—_—'-'---_'_.-_.���-�-�-_--'-���..............................DATE ..........--_-_''_._.__-_ <br /> AD0Tk3NALCOMMENTS ..................................................................................... -------------------------------- ............ .......................... <br /> �'������'�����'����'�'���'��........................ .._....._......_......... ...................................................................�������.... <br /> ---------------e"'---� <br /> ............................ — ................... ................-...................................................................... <br /> '--. -_. .—. .. . <br /> ...... <br /> Final Inspection by: ----.--------'___'_-----_--'--'--'----'---.-'_l»pte--...... ................................ <br /> ^-- SAN ]OAQU|N LOCAL HEALTH DISTRICT <br />