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FOR OFFICE U51~=: i. APPLICATION FOR SANITATION PERMIT'` Permit No..-'7)= 7 L - ----- „ .-. I (Complete in Triplicate)•-'�"- . ..:., -:a � --- Date Issue - ----------------- .- __ -- -- ---------------- - `FIS •y' ;;- This P �rinit Expires 1 Year From Date issued - . '� --- - - -�--"--- - permit to construct and install the work herein Rules and Regulations: " Application is hereby made so mean compliance wial fih CounbtytOrd non a No. 549 and existing ) described. This application I -------- - -- CENSUS TRACT ---------�----�-- -•------ - - � - ---- - ----------------- - JOB ADDRESS/LOCATION ---- C .��-�11.�'--�/----- --------=•---�- - ---.--- Phone ---------------------------•----•--- �r Owner's Name -.---"�--- - Cit ��- --- - Address --�7 - - -------- ------- Phoned � - - t -I -----�--------- -License Contractor's Name -------- — ` Residence Apartment Nouse^❑ Commercial ❑Trailer Court i❑ installation will serve: , Motel ❑Other -------------------------------------------- ------------- --------------•---- -- Lot Size �- ------ 4 X�Garbage Grinder ----------- . - -- Number of living units:_-- r----- Nurmber of bedrooms Private ] Water Supply- Public System and name ----------------------------------- ---------- - - Peat❑ Sandy Loam ❑ Clay Loam ❑ depth of 3 feet: 5and'� Silt❑ Clay ❑ _� Character of soil to a _-If yes,type Hardpan ❑ Adobe'❑ Fill Material yells, buildings, etc. must be placed on reverse sicie'1 ' V � (P1�ofi plan, showing size of lot, location of system in r e�fed 9f pubi�ic sewer is available within 200 feet,( r Q NEW INSTALLATION: (No septi tank or seepage pit P/the ize-__------- Liquid Depth ----------------- -- Size - k PACKAGE TREATMENT [ ] SEP�ICTANK'[ ] " A Ca acit - Type Mate al-------------------- -- o• Compartments ------------••---•---- I " P Y..---- ---- -------- � Foundation - - - Prap. Line - ---------•-------------------- --- Distance Ito nearest: Well - A. Total Length ,---------••-•--•-------•--- No. of Lines h 6f e h line---------- ---- ---- ------------------LEACHING LINE [ ] Depth ter Materia -------------------------------•--------- 'D' Box ---------- Type Filter la!` Property Line - Of Foundation -- --- Distanceto nearest: Well --- Rock Filled Yes ❑ No1 Diame ----------- Number --- ---- - SEEP PIT [ 1 Depth -- Water Table Depth ------------ ----------------------- Line - ( oundation Prop.------------ ---------- Distance.to nearest: Wel -__ - t i ' _ Date ---------------------------------- (Prev. -------------.--G-r---C-_--r•----------/-`- {Prey. Sanitation Permit ---- - REPAIRfADD1TlON Septic Tank (Specify Requirements):- --- - - -------- - ----- s / ----- � d ------------ D. osal Field (specify Reqj ----------------------------------------------------- - ------------ ----- --------- -------------•- ------- r ---- - ..�. (Draw existing and required addition on reverse side} I hereby certify that I have prepared this application and that the work will be done in accordance with San or liceJoaquin rdinances, State taws, and Rules and Regulations of the San Joaquin local Health District. Home owner or icen- County O F ure certifies the following: sed agents signati shall not employ any person in such manner "I certify that in the California:" performance of the work for which this permit issued, as to become subject to Workman's Compensation laws of Owner -------------------- Signed --------------•--- I Signed ... -- ------------------------------ Title ------ -- ------ --------------------------------- BY --- -- (If other than own i FOR DEPARYMENT USE ONLY QP APPLICATION ACCEPTED BY - t --------------=- DATE ..- ---------------- - ----------------------------------------------------- -- BUILDING PERMIT ISSUED ------------------ -------------- ------------------------------------- --------------------- ADDlT10NAL COMMENTS ----------- - -- ----------------�------ ----------------------------------------------------- ------------------------------------------- -------------------- ry- --------------------------------------------------------------------- --------------- ----------------------- ----- -- --- ---------- - Date Final Inspectio SAN JOAQUIN LOCAL HEALTH DISTRICT ,