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FOR OFFICE USE: FOR OFFICE USE: V APPLICATION FOR SANITATION PERMIT ��,,� Permit No... " --- . (Complete in Triplicate) ---------- -- -- ----------------- 4 Date Issued__-------------7 This Permit Expires I Year From Date Issued -- - - --------------------- e - - �.....F - - . 'f �,� a milt , Li Application is hereby made complianceo the SoJoaquiii County'lOrdanta cesNo. 549 and e st ng Rimes and Regulatnd ions:the work herein described. This application is made in /CeCo 1 `oar o 5 F ------------- JOB -- ---- CENSUS TRACT JOB ADDRESS/LOCATION--J-1-9- -- an �/- CV'- . I.9 ,�k «-- Ph e� Owner's Nam it �} .-. -_ -- Address------ -- �. -0/l_X. License # c�s Phone_ =/ t1 Contractor's Nam -_ ---,a �- _ + ` Residence A Installs#ion will serve: partment House E] Commercial ❑ Trailer our ❑ Motel ? s dot Size._ . Q Garbd.ge.Grinder. ,. ,�,� -i I _ Number of living..units:__-/---:------Number of.-bedroom- ,- __ -- = . - - .-- - _ p�rlva e Water Supply: Public System and name k ¢ - . t ` Peat Sandy Loam ❑ Clay Loam Character-of soil to a depth of 3 feet: _ Sand ❑ Silt❑^ Clay ❑ ' Y❑ -•_;_ Hardpan ❑ ; Adobe Fila Matena --------If es, pe - - 1 size of lot, location.af�sy tern in relation topv:ells,puildings -et( be placed o reverse side.)":'P ' (Plot plan, showing ,. t . f k , NEW INSTALLATION: (Na se ti:tank o,r seepage pit' permitted-iftpubllc. ewer is available within200 feet,] P� ,. iS - - Liquid Depth. -----------i SEPTIC�A�NK Size PACKAGE TREATMENT j#1' za _'-No. Compartments-.- -- -- r� ' }" t Foundation..__ P• / -- Capacity YP y /_ n _ a --------------------------- ----------- 8 -._Prone } Distance;to nearest: We�li_: ._ --- ` - " : _ Len hof eat line._.- - = Total e�gth. LEACHING LINE >� . No. of.Lines--- - '- I e th Filter Material__ !- - -------------- - F i D' Sox• :_ __ --T' a Filter Materia c P Yp ,�. _ --- ------- ai Vf --Foundation- -- - --- -Property Lie --- -- t e.,to nearest: Well-,��----------- r b �. De th._ __Number--__6.� -------------- Depth -------= �* T Rock Filled Yes No Distant pmeter SEEPAGE PIT P Dl /. rJ s t t k � ---:---Rock Size-- ��Z__ .� --------------- h _.- -------- � Water Table:Depth.-C1 = �+ -� ---- ---- ----.Foundation -_.Prop. Line-- . "Distance to nearest: Wel1_--:'__/- .-Q--- t t ------------------------ REPAIR/ADDITION Date -Permit (Prey...SAnitaion )I - ' kSe tic Tanye�irements)-- ----------------------- ------------------ -- ----- -- _ .( pec _ -- - -- DisosalField (Specify Requirements): _. ------ ------------ ---------- --------------------- - - - -- -- e --------------------------------- ` ,- --- ---� ---------�-----= ---------------------------------' . (Draw existing and required addition on reverse side) I hereby certify that I have prepared:this application and that the ;work will-be done-in accordance with San Joaquin County Ordinances,. State Laws, an`d Rules` and Regulations. of;the San Joaquin Local Health district- Home owner or licensed agents signature certifies the following: i i his� ermit is issued, l shall not employ any person in such manner as i "i certify that in the erformariCe of work for�whYiih t ti. p to beco j t Wor pn;s Com laws .. fornia. 1 Signed � Jllklsl,R- {� le ` T' BY-4-------- ` r (1f other: than'owner) V11 . FOR DEPART NT USE ONLY 1 ----------- ----------- ------------ ;_ APPLICATION ACCEPTED BY_ = L -------- DATE - DIVISION OF LAND NUMBER-----------_-----------------'------------- ------------------------------------ ----------------- ADDITIONAL COMMENTS--------- --------------- -------- -------- -------- - ----- - - 1— ------- ---- .. . Date- - Final-Ins ection b - " p y:- ----- -- F&S 21677 REV. 7/76 Eli 13 24 JOAQUIN LOCAL HEALTH DISTRICT