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! bR OFFICE USE: <br /> .•. <br /> APP[. MON FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No: .: _._7.�yTl <br /> i;.......................................... <br /> r, <br /> 1s;.. <br /> ___... This Permit Expires 1 Year From Date Issued Date Issued�4._77.6.-_24 <br /> F'A <br /> I )plication is hereby made to the San Joaquin Local Health District for a permit to 'construct and install the work herein <br /> sorbed.This application is made in compliance with County Ordinance No. 549 'and existing Rules and Regulations: <br /> ..7"3 - � <br /> -4B ADDRESSAOCATR _-------------- --_.----- �- °ice,. - _._.....� •------ _... <br /> vet's ame �� - -•6�8 <br /> = Phone .•---------•-......----•-- <br /> dress _._ <br /> ntraetor's Name 7Apartmont <br /> icense 6 _ _ Phone _V_4_T)f�::t�-T�will serve: Residence House i] Coml<nercial otrailet Court <br /> Fallation <br /> Motel Other <br /> tuber of living units:---!•--_--_- Number of bedrooms __4Z,_-Garbage Grinder /ya Lot Size _ !...••................. <br /> I <br /> ter Supply: Public System and name ............. ...Private <br /> iracter of soil to a depth of 3 feet: Sand D Silt ] Clay 0 Peat❑ Sandy Loom-0 Clay-Loam <br /> Hardpan❑ Adobe.0 Fill Material ------------if yes,type............................. <br /> t plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} G <br /> r T j ] SEPTIC TANK( j Size..............:......:.......................... <br /> Liquid .Depth ----------------------­-- <br /> Capacity -----------------___ <br /> --------.__..__---__:.--Capacity _________________-- Type _____.._•----____-- Materl'll ------------- No. Compartments ............. <br /> Distance to nearest: Well _..--------------------------------Foundation .--•-------.-_----__-:.Prop. Line.............. <br /> FCHING' <br /> LINE [ ] No. of Lines --__--__----•-_--------- Length of each line---------------------------- Total Length a` <br /> 'D' Box ............ Type Filter Material _--_--•.............Depth Filter Material ........,..............._................... <br /> Distance to nearest: Well ________________________ Foundation __.____._...______.___.. .Property Line• ................ <br /> 'AGE PIT [ ] Depth -_-----•--•--__---• Diameter ---------------- Number ------------------ --------- Rock Filled Yes .0 No ❑ <br /> Water Table Depth ------------------Rock Size <br /> Distance to nearest: Well <br /> � ----------------------=-----------------Foundation -----------•--....__ Prop. Line .........-........... <br /> WR/ADDITION R ADDITION Prev. Sanitation Permit# ___. Date ................................... <br /> optic Tank (Specify Requirements) ------------------- __-. ..-----_-------....-.___-. <br /> sposal F' id (Specify Requiremen?)..._ _ -, --- - (�__ - ...... <br /> A-A <br /> -------------------------------------------------------------------- <br /> F- ----5C <br /> .................•--•----...----.....--------...---------------••--------•--•-••----._...---- -----------•-------------------------------------=............................................ <br /> (Draw.existing and requi ddition on reverse side) <br /> Fty <br /> eby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sgents signature certifies the following: <br /> F dify <br /> that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> �become subject to Workman's Compensation laws of California.,, <br /> ,. -------------- Owner• <br /> 2ither <br /> F ------ title_r •(If Vctr <br /> FOR .DEPARTMENT USE ONLY <br /> ']CATION ACCEPTED BY - ---------------------------------------------------------------- DATE <br /> DINGPERMIT ISSUED----•------------------------------ -----------------------------,---------------------------------------DATE........................................... <br /> i iTiONAt COMMENTS .. ----•--------------•---•-------•---••--------•--•---••---•------------•-----•-------.....--.............-•-- -- <br /> -_ - ------------------------------------•-----•---- -----------:----------••------------------ •-------------.--•---_.- - :4-'----- <br /> -------------- <br /> -- <br /> - - _-------------------------- <br /> .. .. ---- <br /> inspection by <br /> 7 <br /> Date/d ------------- <br /> ------------ / <br /> l <br />