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FOR OFFICE USE: _ =` FOR OFFI( USE:- APPLICATION FOR SANITATION PERMIT -- 30 ------.K<--------}-------------------------------- Permit No.- (Complete in Triplicate) `` �=1 This Permit Expires 1 Year From Date Issued Date issued___-./.3-_� 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 corr�pliance with County Ordinance)Nb. 5,49.a_ nd existing Rules,andRegulations: JOB.ADDRESS/LOCATION----r _."L-1 ------ ._, _ ._ .__ �f;<� .._...!/LAG ______...CENSUS TRACT.._ r......... -� Ox. .- bV - 1 - --- - ------------------ Phone- Address hone- Owner's Name. -- ttt Address._.o2.7d ----�.---� - -�.�-0 - - - ;� City ��-3-�- ! .-� � ' is71� af✓ �i�- � -License #_ r - ---Phone- 7 Contractors Name____. 4 _ Installation will serve: Residence Z� partment House.❑ Commercicr�T oiler Court ❑ Motel ❑ Other---------= ------ ------ Number --Number of living units:_--- --.___Number of bedrooms__ .___Garbage Grinder_._ Size_ Water Supply: Public System and name- -------- -------�-`F , __. ► +r`. __ I I Private •----------------------- -Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat 0• Sandy Loam Clay Loam ❑��' [ Hardpan El Adobe E] Fill Material-_.._ L If Yes;type_ ____________ ------------ {Plot plan, showing size of lot, loca�ion of systemlin relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewe V!s available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK [Ar- Si-,e__S-?f ___F.______ __- . _____Liquid Dept[�._��---- Capacity�c..&O---(; ype--_-__--- Materiai"� r-�N;o iCom ar e. "'`�'-- ------ - ----------�---Foundation _. f p tm. rets-- : - - R- / Distance to`nearest: Well.. {U�__�-vf— ''�___ ,: o- 2� -_-_-Prop. Line-_-___,�fG L V V[ No.-of Lines-_--�-; --------------Length of.,each-line ._— _ .Fotail Length.-1124. r¢�r 'D' Box__/._-------Type Filter Material_.7.`_ 44-4-__.Depth Filter Mat ri ------------- --- --- _________._. Distance to nearest: Well__.___100-_f----- Foundation---__--o'& ;__..Property Line__.5 __--- f-------- . SEfPAGE'PIT [�] Depth--------i--------Diameter-----------------.--Number---------- _________ ��` Rock Filled Yes ❑ No ❑ Water Table Depth--- ------------- -- ---------- - ----- ------- -----' --Rock Size._. ��----------------------------------------- c7 } '► Distance to nears§t: Weil----------------------- f - ------Foundation------- -4_ ---- Prop. Line ----------------- iF . - I _. y REPAIR/ADDITION (Prev. Sanitation Permit# '------------------------------------------------Date-------— } Septic Tank (Specify Requirements)__,-______.._ Disposal Field (Specify Requirements)-----I---------- - - ► -------------------------------------------- ----`------------- ------ r �1 ' 1 ---- --- ------ -------------------- =---------------------------------- 1 "may --------------i----- - -- -- ---- ---------------- -- 7 - - � 4[Qraw exis ing and required addition on reverse side) ' I hereby certify that I have prepared-this applicatiAmandsthahhe°work will be-done,inY accordance with San Joaquin County Ordinances, State Laws, and Rules -and Regulatio' n's'--of the Sari Joaquin Local Hedith`District, Home owner or licensed agents ► signature certifies the following: ` "I certify that in the performance of the-work f which this permit is issued, l shall not employ any person in such manner as to becomesubect tW k ans ompensati fas of California." Signed GL } -'- ----------- ---- --Owner i ` By--- --------------------- ----- - -------------------- ------------- -° Title------------------------------------f ---- ---- ---- - ----- -- - ---- -If other than owner' -�- } R D PARTME ,1JSk ONLY—t y --- ---------- ---` - ----------- DXTE I 7 - APPLICATION ACCEPTED BY.--------- -- /� ----------------- --------- - V--�- �---` -----�- �-- %,;Is ` ' . DIVISION OF LAND NUMBER. ` ------------ ----- -------- ------- ------.DATE --- --------------- ADDITIONAL COMMENTS 1 �w « cF� C. '= # - - ---------- �_ / s.�t t ---`- J� ------------------------ - -----------------------_- --- ---------------------------------------- -------�j --- -- ---- - --- ------ -- - ---- Fina! Inspection by C S � rL. ` ,12 �y '�C1�#e - - EFr 13 24 �gg F 7 REV, 7176 3M 'e�PL�C� W[J QUI�LOCAL��E E0 TRI�GCOAi I.ToOe I d/r #V& a whwl