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re. FOR OFFICE USE: ` APPLICATION FOR=,SANITATION PERMIT FOR OFFICE USE: --------------------- �. (Com lete in Triplicate) Permit p p . ----------------- - ---- - --.-- This Permit Expires 1 Year From Date Issued Date Issued---q-_- _"7�--- lth District�for a permittto construct and, install the work herein described Application is is hereby made to the San Joaquin L��F-H � . . This application is made in compliance with County Ordinance No. 549 and a isting"Rules and %Mations: JOB ADDRESS/LOC ION.---. -_-�- / _--- -_- . ----- . J-- ---r ---- � ----- - ------ ------------ Owner's : _ = ..__.0ENSUS TRACT.----- ---- --- Owner's Name-- ------------- ------' --.-Phone Address-------- f ._ -- �-- City.---------- _ _ -- ---- ---- -- --- zip-- - Contractor's Name i #�rA.r/7/- -- Plione - License Installation will erve: ; - Resiencs ❑ Apartment House ❑ Commercial ❑ Trailer Court.❑ t . a + .. Motel ❑ ' Number of living units:--,,---/-: � - ' � ---------- -_- ------- Number of bedrooms-'- ; --Gorbage Grinder------------Lot Size------ ----Water Supply: Public System and name----------- :- °2 Character of soil to a depth of 3 feet: Sand Silt Cla 1 Private Q ---------.. ------------ - ------------- - P ❑ ❑ y ❑ Peat❑ Sandy Loam El- Clay Loam Hardpan n Adobe:❑ s Fill Material--.__ f�yesltype`_y<�.______ . 1 i 1 [Plot plan, showing size of lot, location of system in relation to:weils, buildings,-etc. must beplaced on reverse side.] i NEW INSTALLATION: .(Noise tic tank ,or see a e ` it E p 3 P g p' permitted if public sewer is available within 200 feet,J PACKAGE TREATMENT [ ]' 'SEPTIC TANK : Size--___ _ ` d acity �7 Q --- _---- . Liquid Depth .� Ca P Y oc-dv TYPe ✓� `--Material--- ---- ---------No- Compartments......� ...Distance to-nearest:..Wel.l-_/ � - -------- --------- -.t7_f_.----- - -- = -jFvundation.,/-f> _.Prop. Line----- i LEACHING LINE: [,1 No. of Lines_?-- l � � D' Box f e ._ Length, of each line._._- �1 .. _. Total Length., - - ::/ f 4� . yp Felter Material-_- �oundatro�ilter-Material_____ Distance:to nearest: WeIL._ . --- _ --. I 3. [ , � - . ` r' P Line -- / �.. --- Number--- ------------- Rock Filled Yes l De th-� : Nof❑ ht WaterTable,Dept -- '------------- Rock Size_ ------- -- Distance to nearest: Well.-__-_ Foundation-= (� . ] l� {`, ----------Prop. i Line-- ---------- -------- -------------------Date-::' = REPAIR/ADDITION (Prev. Sanitation Permit#-----. ' ..------------- - -------------------} 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 Ordinances, State Laws; and Rules-and Regulations of the San Jotiquin�`Local Health District. Home owner or licensed agents signature certifies the following: "l certify that in the performance of"the work for-which"this permit isL,issued, I shall not employ any .person in such manner as } to become subject to Workman's Compensation Jaws.of California." s l Signed_ed_ ---- .___Owner . :Title -------------- ------------------ [If t e than owner] I FOR'DEPARTMENT USE ONLY t APPLICATION ACCEPTED ,. -- - -- �---------" ------.--------- -----DATE. = -�--�-... =_---=- - ,. �WISION OF LAND NUMBER_ '---- -- ---_-==--.DATE ------------- -- - �.. ---- -- ----------- -- ---- ---- z MMEN75 - = - •- _------------------------------------ --------- --- ---- ------------ -------------- .------------------------------ ._-- _--- ----- - --- -- -- --- -------- - -._G-- -_ ----- __-___- ---- • -------------� T -- - ----- - -- CT � -------- .r �,�---- ---- ---------- - ------- F&S 21677 REV. via am---- ----------Date.---� " JOQUIN LOCAL'HEALTH