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^" OR OFFICE USE. ` FOR OFFICE USE, <br /> ✓ APPLICATION FOR SANITATION PERMIT C ,f` <br /> Permit No. .�/-�• . <br /> ICernplefe in Triplicate) <br /> Date Issued ..j.�..1.. . <br /> This Permit Expires I Year From Date Issued <br />•cation is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein descrifbed. <br /> application is mode in compliance with Count Ordinance No. 549 a d existing Rules and Regulation%: <br /> ADDRESS/ v` .......... ..... . . CENSUS TRACT. ................ .... <br /> ` Phone <br /> . ........................... <br /> per's Name � _ .......................... .......... <br /> City <br /> Iress � Zip . ...... <br /> _. license # `I Y/t/'/ f�" C�" �7.. <br /> Phone.. <br /> tractor's Name -. 0 <br /> allation will serve: Residence ;kApartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other ........................ <br /> rnber of living units: / .. Number of bedrooms L�• Garbage Grinder............Lat Six e.........q <br /> Private (� <br /> ter Supply: Public System and name - ' . .... "" <br />,rocter of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ �Sondy Loom❑ Clay Loam <br /> Hardpan ❑ Adobe❑ Fill Material If yes,type . -- . .-_ <br />!t pion, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) Q, <br /> N INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available w;thin 200 feet,) 7� <br /> y �..�. Liquid Depth .' <br /> CKAGE TREATMENT ( j SEPTIC TANK [ ) Size � x �-�' "� ' <br /> Material.. No. Compartments .. .... . ` <br /> Capacity �G�O. Type .,,,� 0"... J <br /> Foundation .. Prop. Line <br /> Distance to nearest: Well. <br /> . C <br /> . . Total length <br /> kCHING UNE O No. of Lines 1� Length of each line _/ .Q... . .. • I-,r <br />--� 'D' Box r Type Filter Material ! Depth Filter Material. o. - V <br /> Distance to nearest: Well <br /> Foundation.. . . ........... _ Property line_. ... <br /> Y Rock Filled Yes No <br />'PAGE PIT [ ] Depth �� Diameter_.• � Number � <br /> Water Table Depth.......................... . <br /> .........Rock Size.. . ...1 <br /> _. _ .. dation..... . . ... Prop. Line <br /> Distance to nearest, Well.. ..�...0.`V Foundation..... ) <br /> PAIR/ADDITION (Prey. Sanitation Permit#t.................... Dote.............. .. <br /> ptic Tank (Specify Requirements) ...................... <br /> sposal Field ISpecify Requirements) ........... <br /> _ . .............. ... ... <br /> (Draw existing and required addition on reverse side) <br /> will be <br /> one in <br /> oncis with Son <br /> isteby <br /> incin os, St t that 1 hove prepared <br /> tais application nd Regulationsnoftlat the the work <br /> Joaquin in LocaldHealth District. Home Homy owner or,lecensied agents <br /> dinonuss, State Laws, and ti <br />?notwe cerci/les the following: person in such manner as <br /> Certify that in the performance of the work for which this permit is issued, 1 shall net employ any <br /> 13acome subject to Workman's Compensation laws of California." <br /> gOwner <br /> ned <br /> Title <br /> ( %her than owner) <br /> R DE _R ENT USE NLY <br /> DATE <br /> ;'PI.ICATIOti ACCEPTED BY ti DATE <br /> viSION OF LANG NUMBER <br /> DOITICINAL COMMENTS '� � / � • <br /> � <br /> Q I� .. ... Date 7/7�!M <br /> - /f ' � ,� .. <br /> . Inspecucn by: / / ? Ms 11677 lkry <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT <br />