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FOR OFr--ICE USE: - <br /> APPLICATION FOR SANITATIO�R 7(': OOj <br /> �� Permit No. . <br /> (Complete In Triplicate) <br /> This Permit Expires 1 Year From Dote Issued Dote Issued '1.2. JL <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> described This application Is ma/de in compliance wirh County Ordinance No. 549 and existing Rules and Rej ulotlons: <br /> JOE AJDRF.SS/LOCM611, <br /> N tfi ���1rj <br /> CENSUS TRACT <br /> Owner's Nome Q/ 'hF"✓C� <br /> . / y . Phone 2 <br /> Address 11L, <br /> City <br /> ��,7 � JjlG/£��'%.S/' . .. <br /> Contractor's Name t/�Gl� 4�/ y�x License # . Phone 7` .. . ....... <br /> .�• <br /> Instailation will serve: Residence j Apgdau ti 44ajA40Wommercfal j]Trallor Court (] <br /> Motel 17 Other <br /> Number of living units: Number of bedrooms ....Go bage Grinder Lot Size . .lU. <br /> Waley Supply: Puolic System and name . . ... _.. 4 .- lf, ', <br /> _ .... .................................... . .Priv to❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy ❑ Peat f] Sandy Ioam ❑ Clay loom <br /> Hardpan❑ Adobe 0 FII(Motorial . .. _. If yes,type ...... .. .... <br /> (Plat plan• showing size of lot, Iccation of system In relation to wells, buildings, etc. must be placed on reverse sloe.) <br /> NI:W INSTALLATION (No septic tont or seepage pit permitted if public sewer is available within 200 feet,) <br /> Pj�CKAGE TREATMENT ( ' SEPTIC TANK Liquid Deprh ...... ............... <br /> I — � ] Size— 6 <br /> ... <br /> Copouty Type a•Aaterlal.. ... No. Compartments <br /> ...................N <br /> Distance to nearest: VJell ........Foundation <br /> (;:ACHING LINE O No. of Lines length of each line <br /> oi.................. <br /> Prop, Line ., <br /> Total Length ... '... ......... Vl <br /> 'D' Box Type fill,r Moterial . .Depth Filter Material ...... <br /> Distance to nearest: well <br /> fEEPAGE PIT Foundation . Property Lino <br /> ( 1 Depth Diameter . Rock Filled Yes I❑ " "No(]V <br /> Numbor <br /> - - <br /> Water Table Depth .. Rock Size _. ;y <br /> Pro llna . <br /> Gistcnce to nearest: Well ._... Foundation N <br /> Prop. ................... 1 <br /> I EPAIR/ADDITIGN(Prev. Sanitation Permit o <br /> - J Date .. ......_ ..... .. .. i V` <br /> Septic Tank (Specify Requirements) � <r ../ <br /> Disposal Feld S / �._................... ........... <br /> p I pecify Requirements) .. (� .,.. •••: Vie, x/5 % � ��, A � <br /> tr ... ........... .. <br /> raw existing and required addition on reverse slciv) . ..... . .. ................ <br /> I tereby certify that I have prepared this application and that the wo,k will be done In accordance with n Joaquin <br /> County Ordinrncvc, State laws, and Rules and Reculotions of the Son Joaquin Lacal Health District. Homo ov nor or Beers• <br /> sad agents signature certifies the following: <br /> "I certify that In the performance of the work for %hick this permit Is Issuod, 1 shall not employ an <br /> E' P Y Y Pelson In such manner <br /> as to become subject to Workman's Compensation laws of California.,, <br /> 1 Signed <br /> . . OwnerBy <br /> -- / <br /> a <br /> (if other than owner) Title <br /> J <br /> FOR DEPARTMENT USE ONLY <br /> Al; by <br /> ISSUED DATE <br /> :U r:J .u,^,ErJIS DATE <br /> Date <br /> l.rl JGl.<�Uit1 LOCAL HEALTH DISTRICT 8/71 3M <br />