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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT • •k t F- 1 Permit No._.-7- - �� r � I (Complete +n Triplicate) "- �` ------------ - Date Issued ----------- 16 ---------------------------------- �... Th'+s Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District 549 andrexistmit �g Rultes and Regulations:ruct and install the work herein described. PPOrdinance This application is made in compliance with County T ._ _ --- . TR p' � CENSUS SACT { JOB ADDRESS/LOCA ON---------- -.Phone ' � _ _ _ -- ---- - --_ - -- -- -- - Owner's Name f --�/� ------- i -- a B`- '6 ---- - city zi Address hen f .. t, � - L r '------1 -----; ---- --- - icense # ��l S-3� iCourt, Contractor's Name------- -_- - ,_ _ -� �-•- �••• R� ' Phone:- Residence '- '' 'Commercial ❑ Trailer Co t:❑ Apartment House i Installation;will serve: - otel ❑ -Other--. " ._. ., . �.� ------------ ------j i s Lot Size `=---- ----' - Number of living units:_._,-_-_---Num ber.of bedrooms_._.- Garpage Ginder_-.----- -- ---- - _.,-Private ❑ __. r I Water Su I Public System and'name �_----- ---. k PP.Y T. ` Cl Loam ❑ Character of soli to a depth of 3 feet: Sand ❑' Silt❑ _Clay ❑ Peat❑ Sandy Loam ❑ Y Hardpan Adobe. Fill Material---- ---If Yes,type------------------------ --- i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on revexse side.] .t i rt ermit#ed if public sewer is available within 200 feet,] N: (No septic tank or seepage p' p + ;�T:.. ... t Liquid Qepth ' a., - ---�•— Size-=---- -- -- -- = -- ---------------------- -- NEW INSTALLATION. PACK AGETREATMENT[-']""'"S-PTIC`TANK i;} is I T e`- = ` Material ----=----'-- -----` No: compartments-------- ; i t Capacity YPr "�. �_ . ---Foundation -- -- -- -- -- ------------ Prop. Line -- I ..Distanceto nearest:Well' - ------ Total s • T e g Len th of each fine otal_L n th :_ - LEACHING LINE [ } No..of'Lines :- - - 9 . a -- ? ter,Material _- t- Depth F+Iter Material D' Box YP -T e Fil , ; s: i ......_ r .e - ne ..-.__ ----------------- 11 •Distace to nearest. Well " -- -- Foundation k-----------------Property Li � a - 4- . - ., . 4, i,Rock Filled Yes.❑` No❑ r ` Diameter -- - --k Number - --------------- SEEPAGE PIT [ } Qepth ---------------- ------ . E. Rock Size . - Water Table•Depth._ ..,__t- :' -.Foundation--------- - . Prop. Line { / 4 Distance.to ea rest: We ....... ------ ' 1 ► -- _ a - ' . . - ------- -------Date-- � - REPAIR/ADDITION (Prev:Sanitation{Perrhit#---------�---- ------- -- - .�, ...... -- - -- ---=---- ----------- - �- -- Septic Tank`(Specify Requireme'nts]-- 4----•--,- ------ Disposal Field (Specify Requirements ` ` - V" _ , -- ---- , -----------------1'_______ ----_F : . .. . Draw existing and required addition on re rse side). , ccor one in a nce wit I hereby certify that l have prepared.this appli� tion oftthethe San ,loaquinoaquin County wil!Lo al-Health-Distriict.--Horne owner or,licensed agents Ordinances, StateYtaws,-and-Rules,and. Regulations. s t signature certifies the following: _00erson in such 'manner as "1 certify that in the performance of'the work for which this 'permit is issued, I shall not empfloy any p to beco jest to W en's. ompensation laws .of California." r - = Owner. Signed -- ---- -= ------------------ --- -.--- ------ - -------------- --- r i ,� -- --Title tl e ({`,f o her than owner) FOR DEPARTMENT USE ONLY ` ��•n ==----------- ----- - _DATE------ ------ - :---------- ------= -j--- APPLICATION ACCEPTED BY------ . ATE ------- --------- _----- ------ = ---------- - - DIVISION OF LAND NUMBE ------ f - --------------- ADDITIONAL COMMENTS------ ----- � - ----------- -------- ------- .--- ---- ----------------- -------------- ----- -- e ------------------ -------- - ---- ----- t Date -------------------- -------- Final - -- --- ------- - ------------ - -------------- _ Final•Inspection•by - --- Fes 21677 Rev. 7l76 sr EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT