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T OFFICE USE: FOR OFFICE USE: FOR O APPLICATION FOR SANITATION PERMIT . t 7? Permit No._ ------ ` ------------ /Il: _[Complete in Triplicate) �I irt Date Issue - 0. 72 --------------------------- __-----_�I"-__.-- This Permit Expires 1 Year From Date Issued f i i Application is hereby made to.' he San Joaquin Local Health District for a permit to construct and install the work herein described. t This application is made4 in compliance with County`Ordinance No. 549 and existing Rules and Regulations:' �it �_'.-__....__CENSUS TRACT: JOB ADDRESS/LOCATIO '- - .....} [ f> t one-------- ----------------------- -- ' Owner's Name----- --------- a . .. --- Ph - -tip:- _ rr�� r-► ' ' I --------------------------- Adclress -+L.S---------- ---- ` --- ------ tY Z ------------� _1- 14. C q Nps License #. :- � (- r � contractor's Name '- Y. p ' :Commercial Trailer Court ❑ Insfaildtion will`serve: _ i Residence Apartment,House.❑ ❑ J� - :..,�.�.�..�...,,��..;�.,,._,:�' -�--�Mote4�® Other..-•Y� _ _-"'^�`.'-.--- --• ---- /► t6 Lot Size ---..."_ "---- ------------------ ----Nutrnbe'r of living units:_ ._.-!r_ Number.of.be' rooms: 4{Fsarbage Grindex_-- �. aS F { :_ ---------------Private 1` Water u I _Mb—1i em�nd�ncip?e---. - r PP Y t i,, ilr.$� : >s �I Character of soil to a de fih of 3 feet: Sdnd d�, Silt'� Ciay, ❑ Peat ❑ Sandy Loam ❑ Clay Loam D`F ,_..�... ,. — ill erlal- .-- -If yes,type ! t k HardpYar•�„ Adobe " -M�+ (Pio ion, showing Ji oftld , ideation of system in relation--to wells, buildings, etc. must be'placed on reverselside.f NEW 1. STALL�ATION' (No septic tank or s page pit pe i�public sewer is available within 200 feel`,) A ! � pi "% a..._—a tr' i �j�l j/' ------Liquid Depth. JJ SEPTIANK Size - �" - - EPACKAGE TR&TMENT [ T e}7 /�/�/ o. Com artments-- -�-------- --------cItYP Mptarial- P. Foundation..` p.Pro ine-----Distanceito nearest: Well- ---- --=----- ! -- ----------__ ----'Y- e gtth of each lino,---: > . --- Total. Leng�h.__-- i j_---- LEACH 3�IG LINE, No,,of Lines ._ - L' t 'D' ox__}-,C ",Type,0ter Material_ ----DeptE7 Filter Material__' , _- L --Dis# nceto nearest1Ne11. '_ ---- :--- Foundation 6�-- ---- Property ine_I �- - 5P Rock Filled Yes NSEEPAGE PIT -De th - -- iame _- -----.--Number_V+ r Table De th_ ------------------ W i Rock Slze - P --- ---=- ---------------- ' ��p n �- Ili �� w Form ation..._ ----.Prop. Line------ -------------------- Distance,o nearest: WelI_-_—_ f0U.----- ---- - -- REPAIR/ADDITION (Prev)S-i itatit5n-Perm'it-#__;---�— ----:- D_'ate-- ------ - -------------------------------------------- ------ Sep-� 'c Tank (Specify Requirernents)---- '='- - -='- ------------ ---------------- ' -------- -------------------------- poI Field (Specify Requirements) -----'-- ------ ------Dis s i 11. --- -- ----- F --- --- ------------------------ -_ - ---------------- ___ __---------_ ^ t - (Draw existing and require a dition on reverse side) hereby certify that I have prepared this application and that the 'work will be' done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of"the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: : i "I lertify that in the performance of,the work for which this permit-is issued, I shall not employ any persl�n in such manner{as to becigme -subject to- Workman's Compensation: laws of California."-_... LARENCE'S SEPTIC & SEWER SERV1Cfl I -__Owner -263.So. Oro � StocStori, (Alit.y952fl5.. Signed /Zvu� ,. Title - - -- -g- --- - --- ,12� QoniraGi is Lic. 26717 - -----------------------'-------- 13y, ---- le- Ph. - �9 1 (Ifother t an ow FO 'DEPARTMENT USE ONLY" APPLICATION ACCEPTED BY DATE ---- - -- --- ---- :i DATE--- ----- ,�1------------------------------------ DIV ISION OF LAND NUMBER ----------- --- ----- ---- - -------- - -�- --- ----- ------------------------------ - -- ADDITIONALCOMMENTS-,G------- - ------- --------------- 1 - -•------------------------------------• ----------------------------- ----------------- s C. - -------- ---------M-------------- --------=------------ ------------------------------------- - - -- - --- ---- ------ -------- ---------------------------------------------------------- --- ------ ----------------------- - Dafie Final Inspection b an REV. 7176 M -------------------------------- ----------- ----- ------ - z=7- EH 13 24 i�` ' SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21 3 i