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- FOR OFFICE USE: n APPLICATION FOR SANITATION PERMIT it No. ....-_.. (Complete in Triplicate) Perm •••••••••• i ......................................................... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ��77 qp r JOB ADDRESS/LOCA 2_—'73 . Z _ _ � h -T1G�� .................. -Phone ....................... Address .........-•-........ 'S. ..i?Z City . . _ Contractor's Name ...........: ... : :-.:. . :......___.:.License t Y� .'f_-..... Phone`i . / 3 "�� ......_ _ Installation will serve: ftsidence)f Apartment-HouseQ-Commercial-OTraiter Court,-El- Motel ourt,-ElMotel D'Other ................._:-.....__.. ............... Number of living units:......,. Number of,bedrooms:.-._.....Garbage Grinder. .. .` .. tGt-Si;e .__.�.....X� Water Supply: Public System and name .... . -----••-------_.._.._..-......-...._... _. .. Private Q Character of soil to a depth of 3 feet: Sand'[] ilt Q Clay ❑ lipeat�Q andy„L•odm Q Clay Loam❑ Hard an'[. , Adobe Fill Material ... If yes;type ....................... 4 (Plot plan, showing size of lot, location of system in.relationA wells, buildings, etc. must be placed' on reverse side:) NEW INSTALLATION: (No septic tonk•.or seepageitpe m tted if pubf is sewer is available within 200 feet,) V PACKAGE TREATMENT ( } SO i C T�iV1Cx]' Size................. :............. Liquid Depth ...-.....;............... "N ----......- q _ -• Capacity.. ... Type ................... Materibi...L.....;....._;..._ No. Co partments ..................... . Distance to near&t- Well :- ..._....__.'................ `undbtioii. .. Pro L'n r. i. P :._.._.: LEACHING LINE ( ] No. of Lines length of each line _-Total Length .. ................... tipe FilterMaterial ..... ....:.........DeptgFi ter aterial :: na-.:._._.._.-nce to'-neell ----•-.--------'- Foundation ___.._..._ Property Line -:_SEEPAGE PIT O ,fl th iameter ..._.._._...f: Number •_ �_ Rock Filled Y s o IWater ,�able Depth. .....:............ .......... t R k Size -.:_._... _... ..._._. 1 Distance to nearest: Well 3 Eon_..............�; ro :-Urme -'-~- REPAIR/ADDITION(Prev'. SanitationPerit# ......... .:......'............i............ .Doti ...................................( } -Se tic Tank (S fJ,Q, A p pecify Requirement) ...0..�-.�_•.Q,,.l`rr['Ic / - �.:_.....-� �. } r Disposal Fi i i _ • p e 8 (Specify Requirements ._e.r.-ti_.��:�..�..... ......... .................... .......................... .......... ... .............. ....-...___-..._.. .... ............................_..-...... -..._'. .. ........... ............... i : ........... . . . . .....-- -.-.......... �E;..�.. ..I. _....... ..__._.......__..........-_.._._..... .---- ..__... ._..._ . .( LoW ex--►•sting_and_reguired Wdition on reverse side} j I hereby certify. that I have prepared this application and than the work will be done in acco dance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sa*k4eagvin Local Health-DisiAct. Nome owner at liceit. sed agents signature certifies the following: i "1 certify that in the,performance of the work for which hthis>A t i is$ , I shall net employ any person in such me:nnt as to become subject to Workman'sCompensation fawi of Califtbtrnia." l Signed .... ..XV ..--• .............•-----._ ........ ..•! Owner By .... .. -.-:- ... . ................................ ;tle . ... - . . f o er n owner) FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY .. ..................... ..........._.�........._..... DATE ........ ..............~... .......... ' BUILDING PERMIT ISSUED DATE ADDITIONALCOMMENTS .................................................................................-..--............_..-............ .................................. ....................:...:... . .......... ......... .. ., . .. t�._ .......................... Final Inspection by: ...... ........ . ` _.._............:_.Date ./ ..... ..._.__..._-•-• SA JOAQUIN L AL HEALTH .DISTRICT ,. E. H.13 24 I.-A.4 epi qm 7179 3 M