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FOR OFFICE USE: /APPLICATION FOR OFFICE USE. FOR SANITATION PERMIT F ------------------------- -5 (Complete in Triplicate) Permit Na._..._.__��w.-.......__. a ...................................................... Date Issued............... ............................... ... ................... This Permit Expires 1 Year From Date Issued s Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRESS/LOCATION . _�. .....17F�?i3y... L�7_17WOI0` CP ,=- ------------ CENSUS TRACT.-- - ---- Z,47-AIA-010 .` PhoOwner's Name._..... �.............. .i . : ........ ...... ----- ne g S8 ZZ S . . Address_ ----------SE-- ---- CltY .......................... = Contractor's Name.........�`� ./S .. � .SC�W's-----.-- License #-�.s -3�3 .Phone... �'_ ." 6p Installation will serve; v Residence $ Apartment House ❑ Commercial,0 Trailer Court ❑ Motel ❑ Other_.. ---- . ---- -'---- -----------`----- Number of living units:...... ..__Number of bedrooms---3......Garbage Grinder........-.-_Lot size.___..../00 � IQo � . . . -------- Water Supply: Public System and name__... s--------- --- - -- " - Private ❑ :.<.'� Charac er of soil to a depth of 3 feet: Sarid'D< Silt ❑ Clay ❑ Pe at 0 Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AcIbbe.❑ Fill Material . .... - '1fyes, type.............. ._-._..------- Mot _(Plot plan, showing size of-lot, location of 'systern.1n relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: (No aseptic tank or seepage pit permitted if public sewer is available within 200 feet) PACKAGE TREATMENT [ ],r SEPTICTANK [ ] Size,.__...-----:.--------------------- ------Liquid Depth._.-:-•-------------- ----- Capacity_._.... ...- ------ .Type---------- - ---------Material- --------..No. Compartments..------ .......... f J7/SF7pS L Distance to nearest: Well ----------- -------T_ `" :'..Foundation-..-:.. .. .___.Prop. Line...... O .. . ......: X'1&1-4b7 [ ] NO of,Lines _. .. �` _ ._--..._..Length of•each line.------ -- ------ -- Total`Length .. . ..__-.. .. ..__--- -.------,----� Y X;. - EX/57-IA16 'D`Box '- --...rType Filter Material..-_ -.-.-Depth Filter Material_ ..... -- .............. qk Distance,to nearest: Well---. _ - + --- Foundation_-------- _-- --- --.. ..Property Line----.-_---- ------ ------ ----- `A t SEEPAGE PIT [ ] Depth-- ---...:eD€ameter- --------_--------Number--..-------..-•--------. . ack Filled Yes E] No . --.�=, R Water Table Depth ------------=•------------- ------ ......---_--.Rock Size------. ......._......-- -•-----. 'I Distance-,to nearest: Well........... ........ ..... - __...Foundation --- Prop. Line ..-._ - --- ........ Y �f7 o� REPAIR/ADDITION (Prev. Sanitation Permit#---------- - - _._:Date .____ �c�..63..:.._....... _..•_y - .. _ .. Septic Tank [Specify Requirements)-.- '``- Disposal Field (Specify Requirements)-. ^'�STG�_._ �X+ �X �,S[1.rH!��a -.SO �...T/ EX/sTra/b /SPOsi4G F/EGs' — _- --------------- ------- ' ... ................. . . .... . ............... .. ��.._�. �..-----_... ..... ------ ------ r �r ._ ._' —- -�- - 1 (Draw existing and required addition on reverse side), I hereby certify that I have prepared this dpplication and that the work will be done in accordance with San Joaquin County. 's Ordinances, State Laws, and Rules--and—Regulations of the San Joaquin Local Health District, Dome owner or licensed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shell not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - ------ .._Owner ` S � ----- ---- -------- ----- - ,.By_--- - �----- Title _. � (If other than owner) F R D PARTM NT USE ONLY APPLICATION ACCEPTED BY--------------- -- - ----- --------- -------- ----- DATE .. . ..7.g ... DIVISION OF LAND NUMBER -------------------- DATE. ADDITIONAL COMMENTS..:.--- . -- -' �.'�.,. - -------------- - -------------•-----------__...... -- ---- ..------------.--------- -- • . ...... ...... ...' -- ---- _. --- --- Final Inspection b ✓1. - _Date. Z .. 7. :. .. Eli 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fa�21677 REI 76 3M