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_ <br /> ,FOR OFFICE.USE: <br /> 3C) APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> Date Issued <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 appl.ication is made in compliance with County' Ordinance No'. 549 and existing Rules and Regulations. <br /> JOB. VRESS/LOCATION <br /> Installation will-se�r�,e: Residence E]Apartment House-[] Commercial <br /> OTrailer Court :E] <br /> Number of living units---- ... Number of bedrooms __Ar3___Garbage Grinder --- Lot Size _3�41A� <br /> Character of soil to a depth of 3 feet:' Sand[] Silt F-1 Clay El- Peat E) —Sandy Loom [] Clay Loam F-1 <br /> (Plot plan, showing size of lot, localtion of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feetJ <br /> PACKAGE TREATMENT SEPTIC TANK Size---------- <br /> Distance to, nearest: Well ------ <br /> Distance to nearest: Well -------- Foundation _7_4?�.... Prop`e�ty Line ----- <br /> --------------------- <br /> fDraw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be do.ne in accordance with San Joaquin <br /> County Ordinances, State Laws, and4ules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> " agents signature certifies the following: <br /> certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed <br /> -------' Owner / <br /> | <br /> ' ----� �f ~" � <br /> RTMENT USE ONLY <br /> DATE <br /> BUILDING <br /> _{. --... .~~.^~ <br /> COM _ <br /> — � ..- --_-----------_.----' <br /> ---'—`-----------_—.__-___________ <br /> —'— <br /> /.. <br /> ', ,--------'-----.-------._--.-- <br /> -- ' �— --'---._'—'—_._—'---'---'--'—' —~^�—� <br /> `�'�—'--^-- <br /> v -------------------------------------- <br /> Final <br /> ._____Gno/ —' —' ----------------------Date <br /> |N LOCAL HEALTH DISTRICT <br /> E.H. 9 l'�8 Rev. )N �� ! <br />