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Signed <br />By,..... <br />... Owner <br />; <br />7/723 <br /> <br />FOR OFFICE USE: <br /> <br />APPLICATION FOR SANITATION PERMIT <br />(Complete In Triplicate) Permit No. . <br />Date Issued j/_, <br /> <br />This Permi t Expires i Year From Date Issued <br /> <br />Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br />described. Th;s application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />JOB ADDRESS/LOCATI ,.,N2- f".7. ''' 4{ , CENSUS TRACT <br />Owner's Name. .p.•-•""e'ree- •-•_44. ' Pha-ne'---: — <br />Address .... . 2' .;.r LOg'i City, <br />Contracto;'s Name .. '.‘4:-..r.-...4;', ''•' ' • . License <br />Installation will serve:' - Residence Apartment House 0 Commercial ['Trailer Court <br />A* • <br /> <br />Motel 0 Other <br />Number of bedrooms <br />Water Supp(y:: Public System and name <br />Number Number of living units: Garbage Grinder Lot Sir <br /> Privat* <br />Cloy Loom Character of sail to a depth of 3 feet: Sand El Slit o. CayrLJ.PtflSady.Loo <br />__-- -Hardpan 0; Adobe 0 Fill Material lf yes, type <br />(p)ot plan, showing size of lot, location of..syitem in relation to wells; buildings, etc. „muit 4 be ,plciced: on ever side.) <br />NEW INSTALLATION: (No septic tank or eepage pit permitted if public sewer is available within 200 feet) <br />PACKAGE TREATMENT SEPTIC TANK t 3 Size <br /> Liquid Depth — <br />LEACHING LINE C 3 No:Of,' Cinei ----- .. .. •-• .... -.' . -... Length 'or. each line <br />Capacity Type: Material No. Compartments ' <br />Distance to nearest Well • .,. ........ : ........ .. Foundation ' l: — ' --Ph4;. -Line • i . <br /> • .• <br /> <br />• • '.total' Length-, — i"-- - • • <br />- 'CY Box "' Type Filter Material - :'' ''' Depth • filter Material * . ' -r--•": ... ........... ... ..,:.-........ 4 <br />__,........--...........--..... Di stance•-to ,netiresti.-WelIAT:r.,,,,,..•• ... Ltlegftle• -Foundation----2..... .... ::-. .... . -,--... Properly • Line • ••'• -.'', • - IC , <br /> <br />.. • • Rack : Filled : -.Nei 0 - No tott SEEPAGE PIT ! , Depth .., ....... ..,.... Diameter .... ...'_.....L. Nurnber • ' <br />Water .Table Depth l' . , ' ' - .. ..... ,Rock Size <br />.• . . ' !*t. L .,...,,, ..... __. .tta, Distance to, nearest Well ' a Foundtion . <br />REPAIR/ADDITION (Prey. Sanitation' Permit # Date <br />'Septic Tank (Specify Requirements) <br />Disposal Field (Specify R quirements) <br />Jz 7 <br /> <br />-r••• e-" <br /> <br />• 4•6 <br /> <br />(Draw existing and required addition an reverie side) <br /> <br />hereby certify thcit I have prepared this application and that ' thel work Will 6. don. in taccerdanco with •San <br />County Ordinances, State Laws, and Rules and Regulations of the San Joitaitin Local Health ;Dhhd Home owner <br />send agents signature certifies the following: : i .. :.. . . : : . ; ,-. ....-- • <br />as to become -subject to Workman's C9inpsnsahon laws of California." f* - --,. -------; <br />"I certify that in the performance of the work for which this permit is issued, I shall staf amplioy any perstin in s <br /> <br />1., <br /> Or <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br />FOR <br />'Lee r DATE <br />DATE • •• <br />• Final cti9P by;:. <br />'V 24 *AO Cal <br /> Date <br />SAN JOAQUIN LOCAL HEALTH DISTRICT _ <br />lioµµ•µP•finv,'