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FOR OFFICE USE: �. APPLICATION FOR SANITATION PERMIT FOR OFFICE USE; (Complete in Triplicate) Permit No,_"7 ��J •--------------- This Permit Expires 1 Year From Date Issued N - Date issued:_- -f Application is hereby made to the San Joaquin-Local Health District for a permit to construct and install the work herein described. This application i made in compliance with County Ordinance No. 549 and-existing Rules and Regulations: JOB ADDRESS LOC TZN." . 1 '�'� s ` Owner's Nome__ .�Z - ----- ------- -------------- CENSUS TR -- " Address__ _- l� ._ - -- - one — �p += .1✓ Contractor' Y Contractor's Name---- € -- City - -- Aicense Installafiion will serve: ! -� ' ne_-_ _ 7� v •i Residence `' f e rel rrlent House. _ Pho Ej .Con1mercial Trailer Court Mote!-❑' 'Other 'T �a. --- -- �';' Number of living units:_t 3 i ` -------- ,___ _.Nurriber_ofbedroorrls-_' . " Garbage Grinder_- _.Lot Size _ Water Supply: Public System and name_ _ '::_ - _ ----- ----------- ........... ,� Character of soil to a depth of 3 feet: f Sand -- - -- Private • Sil#� clay t 1 --: ------------ -- - -- - -Pr• t �- , e Hardpan E ; Adobe Y Peat❑ Sandy Loam C7 Clay Loam 0 r { Fill'Nlaterial-_. if yes,type ` ' .(Plot plan, showing size of lot, location ofrsystemin relation to-wells, buildings'etc..must be placed-on reverse side.) "NEW INSTALLATION:, _ • ,. y{No:septic tank,orRsee ge !Alt permitted if public.sewer is available within 200 feet,] # x r ?�[ ] SEPTIC TANK teo! PACKAGE TREATMENT SizeCapacity� d6 ' LiquidDepth ..�_gr_ - - Yp - Maternal: ! ... % r ments : r // . .Distance to nearest: Well_ .:/per#--."" Fo nd �� j amp - ----- -_ ' ...N at � _ „tEACHING LINE Prop: Line-_ r ,.: No- of Lines__ S Length of each line i on_.1 . --.- , _." --- z , ___ a , 1 <k. �, Total' Length._l"7p D' Box . .. -Ty'p ~Finer Material+" r , _... ... " } ` Depth Filter MaterFal--f_-, - -------------------- A—, - -- f SEE 1gGE P!T - Distance to nearest. Well.., .- ` - - -- - Foundation`y__ / :1 .. r[. Pro Deth p e.--------- -------------------------- P .. ..._ #y Liny I --'----Number- -- _Property ti Rock Filled Yes,' No Water Table Depth_. . -_ /Q4" ---------------- Dist ---------- r ' ck.Size 1,Distance to nearest:Well:'- f -C1;� iRo --- ---------------- ----------------------- J � F- --------- -- ---Fo- uridation '------>--------------- Prop. Line.- -�'� J REPAIR/ADDITION (Prev. Sanitation Permit# __�_="_ . _' - : -'{---_ =_ Dater ` ---------_---- ) Septic..Tdnk-{Secify Req'uirements)----=----- - - - -- _ ' s ------ --=----- ,Disposal Field (Specify l-= ------------------ -------- = : ------- ---- ----------------------------------------- --- --------------------- /' �i [_ p y Requirements)_.- .`-._: �,' -- -- ----------------------- -- ------ ------- -------- -- . - - - -- ----- -- - - --- --- ---- (Draw exisfing and required Addition on reverse side] ---- I hereby certify feat I have prepared,this appl cation and that the ,work will i be done in accordance with San Joaquin Coun Ordinances,: State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner ' licensed tY signature certifies the f low g: agents "I certify that in the performance of'fhe work for which thisr4 to become subject, to Workman'sCompensation laws of California.,, Com permit , issued, I shall not employ any person in such manner Pas � Signed__ � - .. BY _.-;_- - , - ----------- -- Owner -- a ; -------------------------------------------------------------- Title- ---- W other than'owrier) ------------ D ARTMENT USE ONLY F APPLICATION ACCEPTED BY-)_:__.___-__:_ DIVISION OF LAND NUMBER+_ ----------- ------- -------------- -------- bATE.- ADDITIONAL COMMENTS = DATE Final Inspection b ----'--------------- ---- -------- p Y f� q� -4 Ek 13 24 ------------------Date.---- ---- -- �- - r � .. SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV, 7/76 3M