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,. - - 3. FOR OFFIC `USE: APPLICATkON FOR SANITATION PERMIT Permit No- 7- - .. ------- ----- [Complete in Triplicate) -- ------ date lssued_.)- e_ -------------- - --"'""- This Permit Expires 1 Year From Date issued -- - ------------------------ -- ermit to construct and install the work herein described. Rules and Regulations:compliance with County Ordinance No. 549 and existR;sting N k Application is hereby made to the San Joaquin Local Health Disty+ct o,r.-e•--. This application is made in camp a CEN TR ACT ,..- ._om - w US _ S l r. _ hone - ; .F JOB.ADDRESS/LOCATIs � I Owners Name rl ._. ---- >�. ---------------------------ity. -� �- 'P . 9 �— t �y Phone, �,?�l=l x^p License #rte Address------- — I , c ---------------- railer Court, Ej I Contractor's Name- --- -- Commercial ❑ t Res�ence[ Apartment House.❑ installation will serve: ,a' Other------ ---------- --=--------:- i/ a r Motel ❑ t i : Garbage Grinder Lot Size _ - -- .. va ---_.Number of,bedrooms_., - private Number of living units:- 1- • -- - - - L I ❑ L p 1 : Public System and°name__. ;�_�W�-.:- s:-:' ---.,-------- - -- ------ -- Sandy oam Clay o am ❑ ., Water u p Silt Cla ' ❑ Peat ❑ - , 1 . e Character of so+l to a depth ofp feet: Adobe ❑ Fill Material__...-:_ If yesi typ ;Hard an ❑ laced on reverse_side.) t 1 : buildirigs,'etc- must be p o • 'f s Ian, show+ng sizelO iation of system in r to wells, {Plot p '4 ' it ` ermitted if public sewer is available within 200 feet,} 1 septic tank or seepage p p y Liquid Depth CATION: {No?sep ' - j J Size -- ... . PACKAGE TRE' SEPTIC TANK [ } - � NEW INSTALLATION'ATMENT +,[ l' ' .� -"---- ---.-,-No.- -Coinportments--------- -" "I Mate'rial___ ___-__--- st: Wel" ---- Ic t TYp�-- � , Foundation- .-Prop. Line - - i - C .city: -,.:--,-:Type �f - ------------ .-=Total . : . �.. ,,. O istance�to rieare `- - -- - � -- T Leg - . - _ Length of - + Line LEACHING LINE [.] 3 Box.- es-: :Type Filter 'Material- ndatio�n`iter Material---- _._Property L Fou Filled N Distance to nearest: Wel -------, _ :_ # l ; i • - -. � j 1,-�--_. -_-- ---: � Rock o� _ . _.,. . Number:----------- _Yes ❑ Depth_ I. ---Diameter_ .-_ _.-. �.: '. SEEPAGE PIT I 1 Rock Size------------ ------------- Table --------- = I t f ------ Water Tdble Depth , ane _ s Foundation-------------- - - ! Prop. L t --------------- ---------- ) Distance to nearest: WeIL;--- "-------- - ------------- i pDITION {Prey. Sanitation Permit#__----- I--_-' I REPAIR/A f t , —�; - .--,---- --- ------------------- Septic,fal':+kr(Spec+fy Req irementsl�--- '=------------ -`r � ---��J--- s�--r��--- -�- -----'------------------------- V t / _ Dis osaltField (Specify Requirements) - - -- -- ------ pt --- -�_ - ------- --J _. _____ -------------------------------------------- . - - —l=s .. • : ------- :. {Draw exist`' ._._. _ ._.. I i t t ii a en -�-- "" -"`�--- -- existing crud required ad�lyion,on reverse side) • weer or licensed g if .that 1 have prep red this:application and that ch+e �erk)uiriILoca donein District. Horne oh San Joaquin rCoon I hereby c Y r Ord'+rtance ; State Laws acid Rujes_,an;l_Regulat%o, of San oast r signature certifies the following: r -_ 'person in such manner i i i i h this permit rs is'sued,'l chalk not employ 011 Y 1 "I certify that in the perFormance of`the work fgr w_ac r R to become subjec- t Workma 's Compensation laws of.-Californ a �� Signet . er C' 1Title. ------- -own ; - - By x !-- - i -- than ownerj' — "r 4 , (l�f ether ( F R DEPARTMENT USE ONLY - 7-------- ----- A'T -�! 'f 4 -------------------------,----- r APPLICATION ACCEPTED BY__- ---. -- + D DIV1516N OF LAND NUMBER ------ ------------ '� ADD�7IQNAL COMMENTS-,-�---_— ------ ------------------- -------.---= --------------- ------------------------------------ e ------------- ` ' - ------ ---------•---------------- Date Final Inspection b 1 -- ----------------------- fss 21e77 xev-7n EH is 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ..r r