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, a' a ` FOR OFFICE USE: FOR OFFICE USE: : APPLICATION FOR SANITATION PERMIT _ r� - -----•--:...................... Permit No,_.-1 I�- �=�r• F. (Complete in Triplicate) -----------------------------•---.------------.- ?-3 -71 Date Issued_--._.-....--_-_-- ---__- __.-""- _- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and.install the work herein described. This application is made in compliance with Count Ordinance No. 549 and existing Rules and Regulations: �/� ! i^.- P[f CENSUS TRACT............................ J08 ADDRESS/LOCATlO�I -!-r-----• l ---�-��- ----�=-- �---•---.....----• • -- ---------------•----'-...___---------• . -�g 't Phone---------- ----------- -•-------•-•-- = Omer s:Name:---.._....-------- • -•-�---- -.�,�..:.............:........ ..........'--------------- -I------- -------._•._ - --- .. ri 1 Adhlress-•-•- ••----:......9WIll-�:......�------------------ ------ ------•_-------------------------- Wit)': (w� ( � --------i.--------•l.---Zip------ --------------------•-- Cohtractar's Namp.. J �f..... ........ ------------------------------------------License # ....._.-._._....- -.-T Phon .� Y�l lnstallation-,will ser�e:- Ra encu Apartment House❑ Commojcicil ❑ Trailer Court ❑ . +w.. Motel ❑ Other---------------------- 0 I Nu ben of living units:---/.-;------Number of bedroom rr�� ` .. sem- Garbage Grinder- .......Lot'Size.. = - : Wgter Suppl�Publ�c�S'sy mond.name..._...-----•- ...:_-—� --------------•..--•------------.....-_---:--••---...-•-----------••-----:-------- ---------Private f 'S� Character of soil to a depth of 3 f-6 - 'Sand-O Uf's t Clay❑ . Peat. •Sandy Loam .Clay Loom p- 1 Hardpan F] Adobe -Mate_riay l --.If yes';type_.__,. �f _ !vr-�. - (PI n, showing size of lot, 110tioonnrofsy,ste t reicrtid6tta w.e.11s, buildings,etc inu be placed on never"se side.) s EW STALLATION: i(No septjc tank"or_seepage-pit permitted if public sewer is-available within 700 feet, / J f quid De�h •t �- ! PACKAGE TREATMENT...� ..] . S&TIC TANK ['] ' �ii�±__"fJ-- -- �--- - -'t�-�;f----:-----'-•---Li p . -------- -•-----� • y Type �M,rr. �lhaterial--- ------------'--•--=-_NdComrtments_.---- -------------- . --- -�! '.. ] r Capac�I ll �....v...,.u,-v Foundation... 0. ........Pro Line__-: � . f D!stance'to_nearest:,Well,...Zl- �dp• 1 LEACHING LINE` _ [ ] No. s 11 ne . .. ........:......Le gih reach line... -------:._--L "- Total Ler7gth.-_ d. .; --- D' �a" : ----. Type Filter h71�t�r a j� _!/%:Depth Filter Material-_`_-C,'- -•-- -------------------------- ------• __-_-_---- ,sCa ics*to es~t�Wi 11--y..;� • = Foundation--------------------------::Proparay,Line _ -- . SEEPAGE PIT [ ] ``ePer Table Depth to -Number--------- Rock' illed Yis❑ No❑ OS, i . :.....................................Rock Size--...------------...--•----------------- ---- i 1 : '11(yMce to neiarest: Well ---..s ------:Foundation--;_----_--"---:---._---Prop. Line.._...)............... .. REPAIR/ADDITION (Prey%- nitatido AeVmit#:..__:: ':1.. ._ ------ ---------------'Date-----------:-----: '--------..---------) , '• Septic Tank (Specify R lremente]-----`----- r -------------------------------- :... ----•---- --•-.� I. t Dispos I Field (Sperifyegwrementsi....... ..--••-- ------------..._.. .... - ........... ... ..................:.-------- ...............• ------_-- ...._ .................... ' : .. ............. = :- .. ------------------------------------- ------------------------------- ,+,--------------------------- �- - t Draw existing ansd required'additioi�_on-reverse side} I I hereby certify that 1 have prepared'thi'siappltcation.fand that theSw{if will be-done in-accordance with San Jo quip County Ordinances,- State Laws, and Rules and•"Re ulations of• the San Joa uin Local 1;ealth District, Home a owner or licensed agents signatu#e certifies the following q "I certify that in -thepeerf rmdn'tr of the worktbh for whiciis permit is issued, I shall not employ any person in such manner as to become subipc"V Workman's-Co pefisation 1aws..of .California.'.' Signed. .-..L�� .. :... - -. S t 7# 1If o er than"" owner)` 1F t � DEPARTMENT USE ONLY - 'f APPLICATION ACCEPTED BY...__- ._ A E^- --- ----- --------- Z �, } DIVISION OF LAND#NUMBER.:....... :..._......: :....... :: ADDITIONALCOMMENTS................. ............................ :....--• --------.........-:------:---=------------------- -----------........------- - ---------------------- ..-..L........................i..----- ----.... -• -_ -- .-....-------------..-................ ._.. �....... — �SANJOA (�' I 'A.---= i_ -.--- - -- - Date-: Q� d Final Inspection bY.---4- - ---------�----••----------...............-�------._. .. -- �...----� >:n 13 za, LOCAL HEALTH DISTRICT FSS 21677-REV.�S _ i �._ . 1