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r _ e <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .... .... .. . �.'.�1 .>! <br /> (Complete in Triplicate) Permit No. .7 <br /> J This Permit Expires S Year Frem Date Issued <br /> Date Issued -.Z.:...'..`f:..7..L <br /> A.pplice:.on is hereisy made to the San Joaquin Lr-al Health District for a Permit to construct and irstall the work horeir <br /> described. fhis ooplicotion is made.;^ cor`trc:once with Countv Ordinance No. 549 and existing Rules and Regulations:' <br /> JOB ADDRESS/LOCATION >.c�f.. ...f- CENSUS TRACT ....5.�.. �...... <br /> rOwner's Name . . ......... ..... _.... . ....f r. , �. .......................-.... _ .....�).-.•�........... .... ahtone ..........-........................ <br /> Address /1ILI.E.T►1.E. ...... ............City . . `��RL�1/.V..................... <br /> Contractor's Nome V+l•DERGF.ct4/ND Ll.T'I_Lt,-T!..E.. ........ ..License # ..-. Phone .............................. <br /> ORI <br /> Installation will serve:' Rvs.dence 0 Apartment House❑ Commer6c! []Trailer Court [i <br /> Motel f]Other ................. ........... ........... <br /> Number of ;;.,;ng units: Number of bedrooms .......Garbage Grinder IVG� Lot Size .. l9 ........ <br /> Water Supply: Public System and name .............. __ ........... ...... ................... . Private [ <br /> Character of sol to a depth of 3 feet: Sand ❑ S/ift[] Cloy ❑ Peat E, Sandy Loom C] - <br /> Clay Loam P_ � <br /> Harupon Adobe 0 Fill Material 4 0:If yes,type ....... <br /> (Plot Flan, show r•g size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sr.rier is available within 200 feet,) <br /> PACKAGE TREATMFNT ( J SEPTIC TANK [ J Size Liquid Depth ............::. �' <br /> — "'.1 -_ Capacity pe Material. No. Comp-.i.Iment. ... ............... <br /> Distance to nearest! Wel! _Fcundation Prop. Line ..................... "r <br /> LEACHING LINE O No. of lines Length of each line tai length ............... <br /> 'D' Box Typ- Filter Material Cscpth Filter Mater al .. ..................... <br /> Dist:,nre to nearest: /ell Foundation Propert,,• Line .. _ ............ ... <br /> SEEPAGE PIT l Depih Diarr.cter Numbe- Rock Filled Yes ❑ No C <br /> -- Water Table Uepth � Roc L-Size �!! <br /> Distarn_e to ne:,r_st. I Foundation Prop. Line ...................... 1 \\\ <br /> R5PAIR,'ADDITION iPrev. Sonitotion P errmt 4F .. Doc .. •.... I <br /> Septic. Trunk (Specify Requiiementsl ` <br /> Dispcsoi F;cid l5necify Pequircrnents! n,F.IL `]iFi-r!IC. L rr -TC Tf1N►: <br /> ��.. T1 a I-IT _-1/\,E_ TC' `J X .� X /% - E <br /> jr-,-1, ,^xiStint+onJ re;1 rerf addition on reverse Side) <br /> I hereby certify that I have prepared this application and thot the work will be done in accordance with San Joaquin <br /> County Ordinances, Slate Laws, and Rules rind Regulations of the Snn Joaquin Local Health District. Home owner or licen- <br /> sed agents si3 wure c.rtifies the failowinc,: <br /> "I certify tha in the p rformance/df the work for whish this permit is ist-.rd. I shall not emnloY any person in such manner <br /> as to becorne svb'c:rt Workma((_ s Compensation laws of Crlifornic." <br /> qj`' P <br /> a S:gnerf rC r .�. ,L r; %viper <br /> C_ <br /> {� rOR 0EPARTMENT USE ONLY <br /> DATE 7I <br /> 1i1'LIC:ii:.i,. .•.;C_fi[:) `) it C', / 1— <br /> I i D1 G r••�i.t.f i i;i.)ULL. (J%�I E <br />