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Signed . <br />(if other than owner) <br />•••• <br />1.••••••• <br />ow. <br />--s:- <br />FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT <br />Permit No. <br />Date — This Permit Expires 1 Year From Date Issued Issued 5?36 <br />(Complete in Triplicate) <br />Application is hereby mode to the San Joaquin Local Health District for a permit-to Construct and install the work herein <br />described. This application is made in compliance with County Ordinonoe-Nor $49 and existing Rules and Regulations: <br />.efettENSUS TRACT <br />..Pho <br /> <br />... , City . CAI ty- <br /> <br />/r1.410/ e;e-e)/e License # 4 4, --/'"1/ Phone 243 <br />dence fiportment House 0 -Commercial 0Trailer Court 0 <br />JOB ADDRESS/LOCAT ON <br />Owner's Name :- <br />Address ,a <br />Contractor's Nome <br />Installation will serve: <br />t.• " <br />-Motel 0 Other . <br />Niimber of bedrooms <br />„ <br />Garbage Grinder Lot Size <br />• • — <br />Water Supply; Public System and name C.,.#.7V-7.-17 • Private _ <br />Character of soil to "-ci depth of 3 feet Sand llt 0 Clay 0 - Peat 0 Loom ,fftt--"" Cloy Loam 0_ ........ <br />Hardpan 0 Adobe 0 Fill Material ' If yes, type ... . .... .. . ...... <br />(Plot plan, showing size of lot, location of system in.relation ta lArells, buildings, etc. must be placed on rev <br />PACKAGE TREATMENT [ ] SEPTIC TANK I ) Site. - ' <br />NEW INSTALLATION: (No septic tank or seepage Pit permitted if public,sewer,is„available within 200 feet) <br />1 . . <br /> i <br />Liquid Depth <br />Capacity ' Type Material No. Compartments <br />- 'D Box Type Filter Material Depth Filter Material <br />Distance to nearest: Well --------Foundation • •• Property Line <br />SEEPAGE PIT [ j Depth 1 - Diameter <br />Water Table Depth <br />Distance to nearest: Well Foundation PrOp Line <br />REPAIR/ADDITION (Prey, Sanitation Permit # .... ................ ...... Date ........ .... . <br />Septic Tank [Specify Requirements) <br />A. P5 <br />3 . • . t <br />Number of living units- <br />Filled , Yes o' No t <br />Rock Size . , ..... <br />Disposal Field (Specify Requirements) ----7 . <br />.41.•wdi <br />+.41, <br />If <br />Distance tb nearest: Well Foundation Prop, Line <br />LEACHING LINE [ j No. of Lines Length of each line Total -Length- ' <br /> .. ••••••••••4 <br />. (Draw existing and required addition on reverse side) -. • <br />rheieby 'Certify that I have prepared this application and that the work will be done in accordance with San Joaquin. , <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or ) <br />I sect agents signature certifies the foilowing:_ <br />+0; <br />APPLICATION ACCEPTED BY ... DATE <br />- <br />BUILDING PERMIT ISSUED -DATE <br />ADDITIONAL COMMENTS ' <br />as to become t to Workman's CornisensatIon laws Of California.", Is,: • <br />"i certify that in the performance of the work far which this permit is issued, I shall not employ any person In such manner! <br /> Owner • - <br /> Yitie • • <br /> <br />...... ........ . Final inspection by: <br /> <br /> Date . <br /> <br />SAN JOAQUIN LOCAL HEALTH DISTRICT- .7; <br />E.H.13 24 Rer.-SAA 7/ 7,2 3 14