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FOR OFFICE USE: FOR OFFICE USE: k APPLICATION FOR SANITATION PERMIT ` — Permit No, -------- (Complete in`Tiiplicatel ---.- _---------------- -- ------- �- y � Date Issued..... t This Permit Expires 1 Year'From Date Issued ---------------------------------- ---------- a Application is hereby mad to the San Joaquin Local Health District for a permit;to construct and instal! thework herein described. This application is made n compliance with County Ordinance No. 549'and existing Rules and Regulations_, (� Q. 490i JOBADDRESS/LO ION .. ---- yA-��- ---�� G.�C:- -i SUS TRACT `� y t �� 11 t Owner's Name...-_ J.- -- 1. - v- _ T j P w hone r / / C - - -- -------------- 1 Address" 1... -'E_- _" - -- ; �"�'�' _ (� Phone- Contractor's ne `'�--f��'-'---�-License # ----- -- 7�� Contractor's �partment �� ''aIns#allationwill serve: Residence House.❑ Commercial ❑ Trailer Court❑ s + ` r _ Motel E] Other:- ----- ---- -- Y. `' t. " Number of living units:--.--- ..-_" _Number of.bedrooms_ a Garbage.Grmder== -_".f Lot Size - -- t�--��, f{ 'ate __ # r -=---�_---'------- -----Priv. Water Supply: Public System and name -- ------------ -------------- ------------ ----------------- - . r. -Cla Pea Y nd LoamCIa Loam A ` Character of soil to a depth of 3 feet: , Sand [] Silt ❑ „._ y ❑ F v �.� Hardpan Adobe ❑ Fill Material--._.." ----If es,type-__--._______ ___________".-- 41 Plot plain, 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 seep ode',pit permitted if public sewer is available withiri 200 feet, - Size-------------------------------------------------- -----Liquid Depth.------------`--------- Compartments--'-4 ------ PACKAGE TREATMENT [-] SEPTIC TANK' [ � � i"" 3 .. _ ateraal_.- Compartments---- . �t3 e-- `• ---� --------�� --- ---Prop. Line._ -----------=-.-� b Dasanceonearest: WelPe -------=, =-M=-----_--- --Foundation--- t� --- s LEACHING LINE [ a No. , Lines _" ---=------Length lvn� each line:-��1.r+- ----- --------Total Length.- ! t , e th Fil#er Material ""-- --- --' ---- -- - -- f p' Box..: _ Type Filter Material_." _ p i F '~ Line.-6 --' _ - -" a _... Distance-to near st: Well T -_ ---"�f__-. ,oun' tion---- _:�� --`----Pop arty De fh_ Diameter_. '-Number ---- -U_0"0 -------- Rock Filled . Yes No__k❑ SEEPAGE PIT [ l P l R ' Water Table ® f Pro ine Distance.to neaiest:'Well-_ ;f � Foundation ---3 --------------P P. L' ----------- --- REPAIR/ADDITION (Prev: Sanitation Permit#:------- -_---'--- - - ----- --------------Date- i"'=- ;--------- ---------}. I Septic Tank (Specify Requirements)------ ----------- - --- --------- -=-------- --- -------- ;--------------------------------- s _r"".I_ ...".-_LL.""""..,"" y" --------------- ----------- Disposal Field (Specify Requirements).__. - E. ---- --------- -----=--- :_.. ------------------ --------- ' I -------------------------------------- ------ --------------------- k #""'�` (Draw existing and required addition on reverse side] o- 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; and Rules and Regulations of the Son Joaquin Local Health District, Home owner or licensed agents signature certifies the following: , F "l certify that in'the performance of`fihe work for which this permit is issued, I shall not employ any person in such manner as , to become su jec to rkman's Compen ior� laws of California." . Signe 5- '` -1� r ,Owns f '-------:Title------ - BY - (If other than-owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- DATE-._ . -.-L-.D-- :------:-=-_----- - -- - - DATE--=--------- ----:-- DIVISION OF LAND NUMBER:----------- ., - - ADDITIONAL COMMENTS------------------------- - -------- ------ ----------- _ -------- -------------------------- -----' ----- ------ ----- ------------- ----------------- ------------ ----------------------- -- - - t --- ---- ---------------- ------------------------ -------- ---------------- --------- --- E # = -------------------------------------------- ------ ----- : ---- x _�...... .4 -------Date----- � ;t � Final Inspection by:,: __�= ftp= ' - - - - - ---------------- i EH 13 24 SAN JOAQUIN LOCAL HEALTH 61STRICT Fss 21677 Rrv.��s 3M