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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: IC;� flete in Triplicate) Permit ♦ Date lssued_�_®2 `'5 -------------- This Permi!Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Loci Health District foraL , This application is made in compliance with County Ordinance No. 549 and existing Rules o d Re �ultatlons•the Work herein described. JOB ADDRESS/LOCATION-- � _ C�-• .arD13a- - - ' i Owner's Name _ ------, ;C ---------- ------------ _ ENSUS ACT. _ '. , Address - - - - - '_ - -- ----- --- -- - ' .__4 Phone (��Qy - ---- -------- Contractors Name._' ` .. Zip ; City_'._+------ ---- --- -------- -- License _ se ;#. _ t_ _ -_Phone Installation will serve: Residence �„ Apartment House.[] Commercial I 4'Trdiie r Court ❑ .: , t R..._; ._ Motel ❑ Other-- -- = ti x = r s Number of living units;_ '---/ -- --Number of bedrooms.._.)2 g Lot~Size Garbage Grindc;r ---- _ F Water Supply: Public System-and name-__ { P - ._ =------------------ I . '�� - -- ----- ----- ---- :_ Character of soil to a depth of 3 feet: Sand ❑ 'Silt❑ private .Clay ❑ e t� Sandy Loam ❑ Clay Loam E] : Hardpan ❑ Adobe Fill Material._._:_-----If es e________ _ 1 _ (Plot plan, showing size of lot, location of system in relation to'wells, bbiidings,etc, must be placed on reverse side.) i NEW INSTALLATION: '(No, septic tank`& seepage pit permitted if public sew_ er is available within 20djeet,) � PACKAGE TREATMENT ( ] SEPTIC TANK r _. _ - -- tt -------- -- quidDepth._c�Y Capacity _:TYPe - - __Maa�bl -No. • Compartments---- -- C i ; ... . Distance to nearest: Well--------LCU ---_7__-- -- r- -:_ Foundation r� f = Pro Line_.._ __ LE CHING LINE �� '' `� r , j p. ] No, of Lines_. :____ -----------------Lengt=--.bepth line_ .4 ----------- -y - 1 _ --_ -Total Length.r_.� 17 -- _ D' Box_..f Type Filter Material__ Filter Material-__---___ 8_.�� Distance to nearest: Well_: _. _� �-_ -- - `tl ' r r ------ -Foundation Foundation_ !7 -- -_---.p_Proper Line - SEEPAGE PIT De th_._ ------------------- r_.... 7 5 I P -5------Diameter.-.__53---:---.Number------ - I - E Rock Filled Yes No CI Water Table Depth- --- - - ----- - -- .Rock Size_ [L it .�7},r, Y� d' TR I -- - - -------- Distiahce to nearest:Well_.'.__-.._gip O__ ,x 's-_--------Foundation_-__-__1D_'-__--- Prop, Line_ ,,2 :�!- ---------- REPAIR/ADDITION (Prev�Sanitation Permit#_' _ _' -_`" h"' ` ; .:Date Se --------- Septic Tank S = --- _ - P (Specify Requirements) - = -_ C ----- Disppsal Field(Specify€ Requirements).�- .:_- t --- -{ ---------------- ----- -- - ----------------------------------- ---------------------- ---------- - _- - - Draw r?xistin and re ulred addition, g q on reverse side) - I hereby certify that I have-prepared this'apphcation and that the work will-be done 4n accordance with Son Joaquin County .• Ordinances,, State Laws` and Rules and. Regulations of;the. San Joaquin local Health District• Home owner or licensed a encs signature certifies the following: g l "�� , "I certify that in the performance 'of the work for. which!Ills permit is issued, I shall not em to an to become.subjec+oto, Workman's Compensation laws of California:; P Y Y person in such mannerfas i .�--„G-- ------------- -------------- Signed-------- ---------Signed-------- ------- ---_ wn BY- - Title- . ---------------If other than owner) - ., FOR'DEPARTMI:NT USE ONLY ° - APPLICATION ACCEPTED BY--- ----- --------- :--_ _ ---------:-----------------' AT DIVISION OF LAND NUMB ' : ° E. -��- �+ �” D ADDITIONAL COMMENTS - = = = - .DATE----------------------- -- :,- -- ---- - ._. -------- ----- -- ------ ---- ---- - ----------------- ------- ------------------------- ------------------------------------ - ' ---- --- --------- Final Inspection by:_-1., __- _ i _ _ --------------------------------- -_Da.____._- ---- g , ... _ EH f3 24 SAN-JO,gQUILOCAL HEALTH DISTRICT F&5 21677 REV 7176 3M