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FOR OFFICE USE: , ` APPLICATION FOR.SANITATION PERMIT _ F _ Permit No. _.- j" -:- r '-.. 'i - Date Issued ).'Z------------- 'TY. "-------- ' r, ,! , This'PermitExpires 4aY.efrom. bate Issued- ' Application is hereby made to the San .Joaquin Local Health District for a permit-,to construct and install the work herein Y described. This application is made in compliance with County Ordinance No. 549 and existing, Rules and Regulations: pp 23x 2 'S CEN8WS TRACT _ ----- N777) ---- -0----- s iOB ADD ESS/LOCATION ._- L -�c �_ _ r 1 '�, I_ - .. Owner's Name - C-----------U1� RJ -----•-----;;'- ----------- Phone - - ' /� 17/119- 1�1140��_ U city y ' f k ---- N` -------------------------- Address :`=Phone -------------------- --------- -PETER �� License # ----- Contractor's � 3 a sidenr prtment Hase Commercial TraileFCourt ft Installation II serve: t .� al Motel ❑'Other ---------- -------- l �20P�0 -��- ------ " Number of living units:__________ Numkier of bedrooms Grinder -4 Lot Size`. ____�___-_____- :! Water Supply: Public System and name --s�.t`R-L_ --t 1 F-E-�---------- St---TE Private ❑ Peat Loam 0 Cla Character of soil to a depth of 3 feet: SandSilt[I Clay C] SandYyLoam,. ❑. . -[]_.-_ ~^� "�` -'" '^- '� Har' a ❑ Adobe.0 Fill Material __ If yes,type ---- ------------- ----- --- (Plot plan, showing size of lot, focat;an'of system in relation to"wells, buildings, etc:- must be placed on reverse side.) N r ! t h NEW INSTALLATION: (No septic tank seepag it permitted if public sewer is available within 200 feet,) f PACKAGE TREATMENT [ ] TANK' Size_f X/ . -x--�---- Liquid Depth _. ------ SEPTIC -.---- d_ C � Material- ON��'i_ No. Compartments Capacity 1._J -27- 0----- Type- -- r LV ,, / !stance to ,nearest: Well -__- '�_Vim----------- ----•-Foundation -F ---_----:--!Prop. Line __.. _._-------.----•- d LEACHING LINE [ No, .'of Lines;____ -------------- Length of each line Z-�___.___ --� Total'-,Length :-`rz ---�--- �Cth Filter Material -------------- b, Box14�5 Type Filter Material / ----------.----,--Dep / 5 Foun - �� ---------- Property Line --- -•- �. -Distance tb nearesf"Well _:_i�- r_ _._:_- dation SEEPAGE PIT [ ] Depth Diameter ----------------- Number -------- ------------------- Rock Filled Yes ❑ No i[] ----- € Water Table Depth ------ -----------' ------T Rock Size _ i- T 7_ -------- ---------------•:--- p• - , REPAIR/ADDITION(Prey. Sanitation Permit# ---------------- Date ----------------------------------) Septic Tank (Specify Requirements) ------------------------------------------- ----------------------------------------•------------------------------ i-------------------------- ' taisosal Field (Specify remenW,, .: �- -------------------------- ----------------------.----------------- , P R Y Re,uq- i- - '- i � t s _ .. '-----------------------------------------------`-------- "` r 1 S-T_ -----------------------reverse srd -; -- — —- ---- f ;✓ y: (Draw existing and required .addition on • el l.rhe`reby certify that I have prepared this applica'ti'on arid`that;the work will be done in accordance with San Joaquin i County Ordinances, State Laws, and Rules and Regulafions of�the,San Joaquin Local Health District. Home owner or liten- sed agents signature c tifies the following: i "I certify h t ' ,r the p ormance of the work for which this permit is issued, I shall not employ any person in such.manner as to bec ubjec Workman's_;,Compensation laws of California." f_�___ .._. Owner ( Signed---- ------- ---- T-(. --- { r 3 L.•.... _� .---....._,� l BY 'h T !tle - (!f other than owner) ''- '•' t % t f FOR DEPARTMENT USE ONLY ! _ � -`--=-`/--�--- DJA�T-E - - APPLICATION ACCEPTED BY -----� ------------------------------------------------ ---------- ----- 71- BUILDING?PERMIT ISSUED ____________ / � ----DAT - ------ s - - r - - T ----- _ .r ' = � ' --7 --AJ �=_r ADDITIONAL COMMENTS = � ----_ ---- -- ----- - . � _ -- . - - bµ--=--- - -- --- ----- ----------- ------ : Date .--�-- -Final Inspection by_�, -- SAN JOAQUIN LOCAL HEALTH DISTRICT z u 0 1-'dSA R"V 511A _