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POR OFFICE USE- FOR OFFICE USE:
<br />APPLICATION FOR SANITATION PERMIT
<br />... ... ........_... .... .. ,, ..-.--...... ....-. -.... 3
<br />t j (Complete in Triplicate) Permit No.- ` ,'.. -. ...
<br />Hate lss+�red.��
<br />W This Permit Expires t Year from Date Issued j
<br />Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein ciescribed,
<br />This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations;
<br />JOB ADDRESS /LOCATIOV -: . Y .:...- "_, _��.....•.._-........ ,.......CENSUS TRACT
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<br />Owner's Name .......... ...... __ Phone4f.-i?
<br />Address- -.. m;r .3..'�j .-... _. - C fiy., Z p `«?..: _ ,..... _.
<br />Contractor s Name..,-....>�.., :..-.:.r.s� ,,., ....license #� � �sr�%�-. PYxone ..J'+��_ii�.
<br />Installation will serve: `� Residence Apartment House C Comr"nercial Trailer Court
<br />t t t _. r• Motel ❑ Other. —+
<br />Number of living units: ........... Number of bedrooms.,!o".Garboge Grinder,/...
<br />Lofi Size..,!''r.�t.s'r"'c.�-'.. .:-..... _ .-...:..
<br />Water Supply: Public System and name_ l...._...... ..,..-.,... ....... ..... . .........
<br />Character of soil to a depth of 3 feet:. Stand Silt (—I Clay Peat 71 Sandy Loom 'Cloy loam 7
<br />JHardpan U ; Adobe. [—j hili Material...., if yes, type ........ .............
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<br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mustbe placed on reverse side,)
<br />NEW INSTALLATION.—' i:1No-septic'tarik'ar seepage pit permitted if pubfic sewer 'avvailobie'within 200 feet,) s
<br />PACKAGE TREATMENT`` r �C �,.- - � � ,. Liquid Depth � '� �
<br />I.);",SEi�TIC TANK �-}�'""- S;ze�d'�(",'Y.i�G� %.�-- . ,. .. q------
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<br />_....� `
<br />,,rte �� .,....
<br />Caracity a�� .,. Type.. Mcxterjal C Gt _ No. Compartments.... ` --•�
<br />'Distance -to nearest.- Weir :.. ✓ ,..._ �',. ..... Foui cdotio» Prop: Line... ,r. J -..... .sz:
<br />LEACHING LINE No. of lines..w, ....'Length ot,each.line ...:-.S!0........ .... .. Total Length .--,. ...� ....... '•-
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<br />,{3' box �,'. Type Filter bteriall i'r ��� Depth Filter Material j........ �..
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<br />r ,,�r+- x
<br />C5';Sttanc to nearest: Well �.� /`' ' <n' tion„�'5 1 ..... Property Line...t.'''��
<br />rf .Diameter, ...-�r���. Number-_- ......... .... 1 Rack Filled `Pesti.. Na �
<br />SEEPAGE PIT Deptl�
<br />Water TableDepth.... :.:.,,..:�' Rock Size- .*� . •..-..{..._,., .. ,._.
<br />`+ Foundation.-- ....- . r Prop.. .�'C1
<br />"DistaricQ to-»eare`sty"1NeIl.� � _ .._._.Pro Line ........ -.._,.
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<br />REPAIR ,'ADDiTltitd )Prey. Sanitation Permit-#. ,-.:-.'y..:....._.._..-...--'.:.-.."�.' Date..._...._._..:_.,._._.- "... ...:........:.)
<br />Septic Tank ;Spedfy Requ;reirients) . * -�-». ....... . ....... �_._ ,,._........
<br />Y... b,..,-_,. .+.� .ten. r
<br />Disposal Field (Specify. Reouir.'errents):. ............. .....�'_ l
<br />.. .....,,.._...............-.-.
<br />t )Draw existing ;nd requireci ciddition on reverse side)'}
<br />I hereby certify that I have prepared this application and that the -work will be done in accordance with- Son Joaquin County
<br />Ordinances,- State Laws, and Rules and Regulationi of the: SanJsariquin Local Health District. Horne owner or licensed agents
<br />signature certifies the following: ' .._... t
<br />"i certify that in the perfo"rhmnce of `the work for which this permlt is'issue' d, i shall not employ any parson in such manner as
<br />to become subject, to Wor mon:,.„Compensation..lows..ref-..Coiifomic.".,.—._-_...-.-...-; --
<br />Signed � s. - Owner'
<br />//yy��//, .. y �r�'J/J/ ♦,. ,may/ J}
<br />j (if'other" than owner) B j
<br />' FOR DEPARTMENT USE ONLY �
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<br />APPLICATION ACCEPTED 8Y -,_1.c .., _ __ DATi .. �-...� � • � f)-•.
<br />DIVISION OF LAND NUMi3ER................
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<br />*ODITIONAL COMMENTS .:.........................•__. :.,..._. _.......-....._.. ...........
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<br />Fxnai lnspectii5n b
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<br />�s_aR "r•,.; `` r„ SAN JOA 1N LOCAL HEALTH DISTRICT � res a,arr REV. rna 3M
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