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; FOR OFFICE USE: ............................. APPLICATION FOR SANITATION PERMIT FOR OFFICE USE. "-- -------------- (Complete in Triplicate) Permit No..-7t--A41a This Permit Expires 1 Year From Issued Date Issued (� 7� Date Id......-. ___ IS Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This aapplication is.made in comp)' nce.with County Ordina to No. 549 and fisting Ru es and Regulations: JOB ADDRESS/LOCATION .... -- 5:.:" .. "" Owner's Name."_ //� / ------..CENSUS TRACT_.-- Address-------- .....---- -- Cit Contractor's Name,-..,_. ..... ..... --- - Y-- .�' ec.r - - .....Zip -- ------- --------.....-•--- ✓t�,q.t.. ..--..._ --- .... License # Installation will serve: Phone ,� �6-S Residence motel meat House Ej Mote ❑ComTpcial Trailer Court ❑ i l Other�:-. Number of living units:.. ❑ ) _.Number of bedrooms. _ Garbage Grinder Supply: Public SystSize !x47 .'—iS em an name-- -------- ---- Character -- - - P Character of soil to a depth of 3 feet; Sand . ' ---•- rivate ❑ . Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ sAdobeP'�ill Material.. __-: --- If Yes, t (Plofi plan, showing size.of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side. NEW INSTALLATION: E a ) (No septic tank or seepage pit permitted if public sewer is available within 200 feet PACKAGE TREATMENT [ ] SEPTIC TANK i t Size..----- �a -0!� ,1 Ca aeit Liquid Depth... p y-. «d " Type..- '...Mate4I _i.6. �- rC� No. Compartments Distcinceito nearest: well_..-...8W ,: Foundation..4,re- �Pro ' LEACHING-LINEI �G l `No.-of-Lines ......... ..... Prop. Line ]2"� - .Length�bf each line,.----- "..�(J s - - -----------'Total Length .. �. `D' Box._ T ...... ...... •-�-SCJ ype Filter Material{?,�a.C-.,-:Depth Filter Material._--._.t{j_r�_--..,.-_-_ SEEPAGE PIT D'sptanceto nearest: Well---- _ Number ndation---------i-U. -- Property Line.ry_.--- - o,-_ I De th----' ....- ..Dlarneter-:��;-__�---- -------- ------------------------ Rock Filled Yes ❑ No ❑ Water Table Depth..-. -------------j. ' ----Rock Size.. Distance to nearest: W '........ ........ ell.-._-.--" 'r""- ..--------.Foundation——------ ...... ......Prop. Line... REPAIR/ADDITION (Prev. SanitationPew mi -- _...... -------- ------Date-- �---•---- ..._..- - �- Septic Tank (Specify Requirements)-"--- --------------- ----- -- --- -) Disposal Field (Specify Requirements).._._"-."------ .-------- - -- - ------- (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 f Ordinances, State Laws, and Rules and Regulations 'of the San Joaquin Local Health District, Home owner or licensed agents Signature certifies the following: "I certify that in the performance of the work for which this permit is issued I shall not employ an to become su 'ect to Workm nCo R R Y Y person in such manner as + tion laws f California.'+ Signed-.- ----- By..---- �" r� caner ------------- ----------- Title / i -----• , (If other than owner} , "a` """ ---------- a FOR DEPARTME USE NLY I\PPLICATION ACCEPTED BY-----".. DIVISION OF LAND NUMBER. - -... ----- ._DATE 4DDITIONAL COMMENTS DATE. --------- ------------ -r------- ..................... ".. . --. final Inspec / __ -----N 13 24 C� fi---- JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 9M 0