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ils',4 i L -a %R OFFICE USE: "` ��'�S- Mi¢�'C. G✓u o �O OFFICE USE: APPLICATION FOR SANITATION PERMIT ��d ?� �a (Complete in TriplLte) Permit No.---7L--'p5 i Date Issued..--//'_ -------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a pe'fmit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 acid existing Rules and Regulations: JOB ADDRESS/LOCAT-ION---.=30 5.3-;_E�' Con�ljsR_d-. Ebcalon,�_ Calif . CENSUS TRACT___---------------------- p i Owner's Name------1�o_ri__-Schu.t ----------- - - .-- - - ----- -- ---------- ------- ----------- - one t.- . . - . ------ P ------_- Addresssca on City,_ SCr -OY� ------------ZAP-------------------- o Contractors Name___Ned_-W. nneI #_ ---- ^._•--=---------------------- ----License •-------" �.. --x.,1.6.36.6---= -Phone-_ Installation:wilI serve: Residences] Apartment House.E] Commercial ❑ Trailer Court'❑ I - _ 3 3 p ._ ; Motel .0 Other ------ ------------------------- A.� + Number.of living units:__,_.1_L------Number of bedrooms.._3-------Garbage Grinder-----?-----Lot Size---- 329,34-1.x .1.0-Q0,24.. Water Supply:-Public System and name--------------Well,;- __Private Ej' . Chpracter of soil to ci depth of 3rfeet: Sand ElSilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan p ❑ : Adobe ❑ = Fill Ma-terial._---------If Yes,type_______________________ (Plot plan, showing size 'of lot,location of system in relation to-wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No`septic tank or seepage pit permitted ifpublic sewer is available within 200 feet,) PACKAGE TREATMENT S [- ] ; SEPTIC TANK � - '' Size - - -----------Liquid Depth.------- ------------------ Capacity-12 ._0---Gn.]TYpe-------------- .__Motorial-__Q_o_n0_ret_e-No. Compartments--:----2---------------------- ---W t Distance to nearest: Well, r -- -• --= -- Fgjjndation---1--0 - _--,--=-'..Prop. Line-- 0 i LEACHING LINE [ Na. of Line� � Z -----Length each line_ Total Length. zC7 ------ - # dy D' Sox. / YP P CJ -' �,: T a Filter Material__. :- �ZDe fih 'ter aterial_._____. -- - --- ' _. Distance to nearest: Well_,_�4-____-._-__ Foundation__/(J___ ______________Property Line_ ___f__ ---------- SEEPAGE PIT [ ] Depth----E----------iDiam6ter :_C_------- umber--- ----------0-_- -._ _ f Rock Fill No ❑� Water Table.Depth. ac iz Wf'� i� F S cid CCti� ----------------- R k S e '= � � -= Distance.to neare st: Well r-------- Foundation------ - ---------------Prop. Line.-------=YRIRI-ADO ITION (Prey. Sanitation Permit#___.__ _ "_� h y -- --.Date_-=-=---- . .r.---��-�------'-�" ------) Wim. �• -�-�--- _ , Septic Tank (S`pecify-Requirements)nts)......:...:.._- `. Dis osal Field (Specify,Requirements) —'------------------------------------ -- ----------------------- -------- -t� - ----- -- ,. ------i------', -,-.-- -- - - ----- 1. = ------------------------------------------ --- ------- ---- ____ ___ crequired addition onreverse(Draw existinde) I hereby certify that I have prepared this'applic tion and that the work will-be done y ray''-aq", dQni�-•with an Joaquin County Ordinances, State!Aaws, and Rules and Regulations of;the S'an Joaquin Local Heal h Disf,Or Home'^owner`or licensed agents 4 signature certifies the following" " T �`ti J "I certif/thati th performance of the work far. which tFiis permit`is`.issued, I shall not employ ani person such manner as to becoect o . orkman's Compensation- laws`�of jCaliforitia.':- . sg5Signed le-�i ----- - Ownar t ` - I -F BY---- --- t �� f ---- _ Title__ ' H . - ___�-- _'.-. ----_.- - - - - - (If other than=owner) y }` FO EPARTMENT USE ONLY APPLICATION ACCEPTED4BY' A-____ DAT y Jl � I DIVISION OF LAND NUMBER:..__-_---. _J<_- tf ,e;T ` E . ADDITIONAL COMMENTS .., + .1 - DATE-_/ z�k sr } i. 1 --------------------- - �,,, ._ --- - - - ----- --------- = .\ ' _4 l �r� F �5 � I l ,•. s� " •-- 't SIA _____________ _ __________ __.-__- `. /. - ----- -_ _____ -- - ------- ----------- ----------- - - _ __ . Final inspection by: -��. f' -_------ _ --------------------I-------Dat .-/ - EH 13 24 SAN J QUIN LOCAL`HEAlTItICT= '.1� F&5 21577 REV.