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u.rrrt mac: <br /> APPLICATION FOR SANITATION PERMIT <br /> 13.......... <br /> Permit No. ................. <br /> !Complete In Triplicate) <br /> ............ <br /> .............................................. This Permit Expires I Year From Date Issued date Issued G 7 7 <br /> A0plicotion is hereby made to the Son Joaquin Local Health District for a permit. to construct and Install the work heroin <br /> described. This application Is mad,� In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAION P_( -Vio..................s4k,4...........CENSUS TRACT ........................... <br /> a, A� <br /> Owner's Name _Z.A.W.4.........&'A4.J4 .................................I——..................................-..Phone . <br /> Address..., ........W#, ....... <br /> City <br /> ...... .. <br /> . .. . <br /> Contractor's Nam CA( ..........................License # Phone <br /> Installation will serve,. side!" <br /> oApartment House C] Commercial[]Troller Court-,0 <br /> ............................................. <br /> f be ms <br /> Number of living Number',o'e,0 Other .....Atl­.Garbago Ckinder ..AIQ... Lot Size ....7_0A.. ................... <br /> 3- t i <br /> 7 <br /> Water Supply: Public me .......CW::.JJ(f. 24;e------- ......... ....... <br /> System dn'd-name' 7..........—------- ........................Private 0 <br /> Character of soil to a depth of 3 feel,-7-� Sand 0' Silt-O'—Chiv-[)—Peat 0 �Sandy tociino day Loam [3 <br /> HardpnC3 Jill M6terlal!............If <br /> a' . AdoboJR_ YO$,type ............... ............ <br /> lPlot plan, showing size of lot;. lo6tion of system In relation to wells,I buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION[ (No septlc tank or seepage it 1peim6ted If public sewer 1s available within 200 feet,} <br /> PACKAGE TREATMENT , ( ] --SEPTIC TANK( Size......................... ........................ Liquid Depth .......................... <br /> Capacity i............ ...... Type .................... Material;..................... No. Compartments ..................... <br /> Distance to nearest: Well, ..........._.....................Foundation -----:................ Prop. Line ............ <br /> LEACHING LINE No. of Lines .::'Length-,of,each line..:........................... Total Length <br /> ........................... <br /> .................... <br /> V Box ...j......._ .Type Filter M,ateddl 3�................Depth Filter Material ............................................ t <br /> -":.,.Pistance,td nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT Depth <br /> ......I.............. Diameter ................... Number .......................... Rock Filled Yet 0 No 0\0 <br /> Water Table Depth_.�..L..........................................Rock Size ................................ <br /> Distance to.nearestt Well ........................................Foundation .................... Prop. Line ................... <br /> REPAIR"/ADDITION!Prov. !Permit# Date ..................................I <br /> Sanitation <br /> . I . ..........*....... <br /> Septic Tank (Specify Requirements) .................. ......... ........JO!6 ................. <br /> . . ... 0.01; <br /> Disposal Field (Specify Requirements! ... ............. .. ........ . .......... ...................... <br /> ........A;A26f............................................................._......... ---------- ................................ ...................... ............... <br /> ................... .................I...............I...................... .............................................................7.................. ............................. <br /> I(Draw existing and required addition an reverse side) <br /> I hereby certify that I have prepared this-application and that the work will be dons in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and.Regulations of the San Joaquin Local Health District. Moms oMe QVM&r Of IlCeft- <br /> Bed agents signature Certifies the following: <br /> "I-certify that In the performance of the work for which this permit Is-issued, I shall not employ any person In such manner <br /> as to become subject to Workman'i Compensation' laws of California.- <br /> r <br /> Signed ....... L 5F. ................ .................... Owner <br /> BY .... . . . ............................................ Title _ e-o ..�. ......................... <br /> (if other an ow <br /> R DEPARTMENT 7 USE ONLY <br /> APPLICATION ACCEPTED BY....... ... ........ ............ ................... <br /> ...................... DATE <br /> BUILDING PERMIT ISSUED ........ <br /> ......................................DATE ........ ................. ................ <br /> ADDITIONAL COMMENTS _., ............................................. <br /> .............. ................. ...... ........................ <br /> ............... ....... ................ . ... . .........................­......I----------------------------------- <br /> ..................... .... ..................... ......I................:................................... .................................................... <br /> ...................... ............ .......­­­­­­­­­­­,........."---•---...............-•--- <br /> Final Inspection by: ... <br /> ............................................................. ................Date <br /> / <br /> EH 13 243-6£3 • AN JOAQUIN LOCAL HEALTH DISTRICT <br /> T 8/7h 3M <br />