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FOR OFFICE lI5E: . .
<br /> FOR;01=F{CE USE ..,_ .. .
<br /> APPLICATION FOR SANITATION PERMIT .
<br /> {Complete in Triplicate) Permit No.....F_ :-. - -�
<br /> Date Issued:7- 6.n......
<br /> :;. Thit Permit Expires I.Year From Date issued
<br /> Application is*eeeby made to the San Joaquin total Health Dktrict..for al permit to.construct and.iostall the work herein.described
<br /> This application, is made in compliance-with County Orclinonce.No. 549 Hirci existing Rules and.Regulations:-
<br /> JOB ADDRESS/LOCATION
<br /> ' " ... :..:.:_ P5 CENSUS TRACT..... ...........
<br /> +-.., . .,
<br /> Owner's Name: `t�3..: ?.t .'+ .t ' .. . .._-............ ... ,. ,.. Phone- -
<br /> Address:.:: ..: diy►
<br /> �i
<br /> Contractors Name 'License #. Phone.................. .. ...--
<br /> Installation will sere: Residence Apartment House 0' Commercial El ?Prader Court.j�_
<br /> 'Motel:E) OtherLat'S,ze..
<br /> Number'of,living units: .-:.......Number of bedrooms.,-_ _....,Garbage Grinder. .. _ :,_. .f✓'... '5t ....
<br /> - s
<br /> Water'Supply Public System and name -------- :'. ...... .......Private
<br /> Character of soil to a depth of 3 feet: Sand $,lt{� Clay Feat.[] Son.dy torn Q Clay.Loam 0
<br /> Hardpan fl Adobe [ Fill.Materlal If yes, type;:.
<br /> ;Plot plat', showing size,of lot, location of.,syster)A71h relotion'#o wells, buildings, etc. must:,.be placed on reverse side:{
<br /> I EW INSTALLATION:, (Nes-,septic tank .'or seepage pit permitted,i#:public sewer rs:available within 200 feet,{
<br /> E TREATMENT { ] SEPTC TANK { j Size Liguid Depth
<br /> PACKAGE ,. _.> � ..; _.
<br /> Capat,tY Type 1�11ateric�i No. Gompaitments....
<br /> i Distance til nearest 11JEii. Foundation Prop L,ne
<br /> r
<br /> ...
<br /> LEACHING LINE [ J No. of Lines
<br /> a :.k Lixngth f each 11ne Total Length
<br /> D Box ype)=riser Materidl E papth'Psterlaterroly
<br /> It -` Bistirsea#ixeares# �Aleii: :`� ` Pound.atran _ .ParaRr. t-,kms.€ .. _._.....,-r.._.
<br /> Rock filled. Yes ' No
<br /> { aEEPAGE PITO Depth Diameter, Number- .
<br /> ."Water Table. Depth,- Ratk Srze
<br /> f
<br /> .x Distance to.nearest Well, Foundation _.Prop, Line
<br /> • .
<br /> REPAIR/ADDITION Prev Sanitation Per t,# Dote i f
<br /> r ..
<br /> peptic Tank (Specify Require ments)F r
<br /> Disppsol Field) pecify Requireents{
<br /> ,y 4
<br /> li3r.isw ezistingartd required add,tion on reverse sidel
<br /> here6 certif that I have re arisci tMs a IiCptign at,d th'«t,the vvor C w111 Iae. 1.done .in accordance 'with San Joaquin Count
<br /> Y y p p pP
<br /> 3rdlnance4r Strife Lawsand Rules and Regulatrana -af tine Sctn�Jaagi,r1 Local..Health Dislrict, Htrtr►e owner or licensed agenl
<br /> signature certifiers the.following:k
<br /> .certify thpif.:in;the•perfarma o#:the work.far.width ,this'perml, issued, I slsali.nof employ any person in such manner a
<br /> r
<br /> V .k►ecom rk en's eirsatio'caws of california "
<br /> By ......:.. .... :....Title ..:.. .
<br /> (If other than awr+e rl
<br /> "FOR,DEPARTMENT USE,ONLY
<br /> PPLiCa710N` ACCEPTED
<br /> fBYE
<br /> f DATE:.. .f .
<br /> DIVIS16 OF LAND NUM8ER....... ;._x:. ... .... ........ . ....... .,.:D --
<br /> ATE:
<br /> ADDITIONAL COMMENTS
<br /> i ...<; ..
<br /> .....
<br /> . .. ._.::....
<br /> Final Inspection by . .... ..:: z., ..----- t
<br /> Dae ..
<br /> er+ 13 24. SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 12107 REV. 7/76 s
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