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ar 1/101 FOR OFFICE USE: )PLICATION FOR SANITATION PERMIT eFOR OFFICE USE: � -- �-�- -- Permit No..,7.�-gra ------- - ------- - (Complete in Triplicate) ---------------------------------- - Date Issued..g-- -7-r This Permit Expires 1 Year From Date Issued - - 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: '/V/ -1 -�" - JOB ADDRESS/LOCATION f 6 l -CENSUS TRACT--------------- on Owner's Name------W. k ---- -------------- `-- ------ - C ty.--------- . ------ ----------e_ Zip--_- - -------------- Address E ----------------------- 4,- --------- -- - '�' License -- ---------- Contractor'sName - _ Installation will- serve: Residence Apartment House ❑s�ornmercial E"-Trailer Court El Motel ❑ Other ---------:---- - ------- � � + Lot`Size--- _. ----- ----------- Number.of living units;--- _.-_Number of bedrooms--_"-..----Garbage Grinder..f_.__ �. ' _ � - Private ' Water Supply: Public System and name---. - ------ ------- -- -----=------------- Character of soil to a depth of 3 feet: Sand ❑ :Silt❑ 'Clay ❑ Peat❑ Sandy Loam �` ^Clay Loam ❑ Hardpan ❑ Adobe.❑ Fill Material_. ...df yes, type--------------=----------------- r r_k R (Plot plan, showing size of lot, location of system in relation to wells, buildings,`etc. must be placed on reverse side.) NEW INSTALLATION: ;(No`sepc tank or seepag tie :pit permitted if public sewer is available within 200 feet,] r r,. . . . --Liquid Depth----------------------=---�+ PACKAGE TREATMENT .[_] SEPTIGTANI4��Q � � Size- --_s2��--- �----- --- ----------- i - ----------------------No. Compartments.----------------------- ----------aYR - t i. . =-_-M-�at--e=r-iaCa citY--- -_=-=~foundation" -----------Prop. Line___rDistance to nearest:Well s (; N.o, of Lines. Y , ' Length of each.I-ine-_-F- -----.Total Length ------------------- C� LINE � ..� - 1 :l 4 :D' Box_. _--._.Type_FilterMaterial / -.Depth Filter Material-- ---•-------------------- t� �� l., �• a Numbe )tion - .Property Line.. Qd_ ' " Y Distance to nearest: Well__ �, l -C � rE, SEEPAGE PIT [� Depth- --- ".Diameter_` { ...------------------ Rock Filled ' Yes No ❑ ] P , i ► � Rodck Size: - Water tfable'Depth - f . ..., rto .. ....x " -- -- - ---Fou at on _ Pro Line.:3 W :.._ Dis alaeenearest:, '�II _.. � � � p• r — g REPAIR/ADDITION (PrevrSanitation Permit#-:' ._,`=-----=-:=" =--- ----'=-- :--- :."Date------ ------ ------------------=-----------_] Tank (Specify Requirements)-...;_+ .__ --->_ -------- ----------=---- . e --------- Septic ---------- -- i Disposal F Id (Specify Requirements)- __._---- - t - ----------------- I -- - -- --------- ----- ---- -- -- -- -- - ----------------------- -- - -- -- --- -. ..�wW--��ar --------------------------- "."_.___..-•"-----:--___-•:.-____.--.-.-_ 4., (Draw existing and required addition:on reverse side) I hereby certify�..'thal I have prepared ,Ihis application-and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: I i "1 certify that ini the performance of the work for which this permit is issued, I shall not employ any person in such manner as I ` p laws of California." . ' tobecomesub'ect to Work n s Compensation 51 ned___ ----- -- --- -- -------- --- . Owner -- "- By= "Title (If of er than owner] R FOR DEPARTMENT USE ONLY E APPLICATION•ACCEPTED BY - --. --- - ----------------------------------------- - DATE , = DIVISION OF LAND NUMBER ----- --- --=----- ------- DATE - �Pa- � AL OM ---- -------------- -- C�bve�lr + ----lv �"._ __ c s 4 ---------------------------------------------------------------------- ------------------.- - ' --- --------------------- ---- - ---- --- - - ----------- w Date Final-Inspection.by:..___ --- -- - : F&S 21677 REV.7/7ti 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT