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nn ��,�� - �, 091JAFOR OFFICE USE: I- #Z,7V,4,C;- APPLICATION FOR SANITATION PERMIT -- Permit No: l-�--q- - (Compiete in Triplicate -. - Date Issued _ q`.__3 -------------------- ------------- ----------------------- ---------------- This Permit Expires 1 Year From Date Issued 2Z�G_ pSp •-D7 SS alfih District morn a Nom549 and ex it to construand sting Rukestalnd Regulations:Application is hereby made to the San Joaquin Local He described. This application is made in com �p�L%St3tJ�oun y�� WOO➢LVAR0 �fr4N�G—CENSUS TRACT ��-`. -- �; - JOB ADDRESS/LOCATION ._ ----------- « +� ------------- -- -- -- --- --------- - -_-Phone y!__...o-f Owner's Name ------------------------------- "" .� _.DA�f� = ------ -- - Address �Lr City ��•77 �- / �� .._ License Contractor's Namei �- (!�L G --------------------------- -- - # , ,/Jrt Phone Residence 'Apartment House❑ Commercial:F Court�',(]�`. ----• f " Installation will serve: tment - 1 Motel ❑Other - ----- ------ -------------- ------ --- --- ..f i 6__4��'-c -------------- _____Garbage Grinder _---__- --- Lot Size ____ I Number iof living units:_____-_- Number of bedrooms __ Private 1 k , ------------------------------ Water Supply: Public System and name ------------- " ` /Peat❑ Sandy Loam Clay.Loam Character of'soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Hardpan ❑ Adobe '❑ Fill Material ------------ If yes,type ---- --- ti ' ,f buildings, etc. must be placed on reverse side.) (plot plant showing size of lot, location of system in relation to wells, i i// NEW INSTALLATION: (No septic tank or seepage pit permitted„if .p�k�i` sewer is available within 200 feet y I}z1�- ---------- Liquid Depth ---- r Size___---------1 - SEPTIC TANK:[, PACKAGE TREATMENT [ ] Ype ,?4t<, �T Material-------------------- No. Compartments ------------- Capacity/A-- ------- T •. 1{ ` Foundation _14------------- prop. Line °---••--=------ Distance to nearest: Well ---f --------- , ------------ yd LEACHING UN'.E1� No. of Lines --____�-------------- Length of each line.___ 9----- Total Length --- LEACHING Box -_- ____ Type Filter Material !r1-Depth Filter Material ___1ff�___---- - r S . Foundation Property Line ------` Distance to nearest: Well -_1 --------- �e--- --------- I No iiCj SEEPAGE PIT [ ] Depth ----------- Diameter --------------- Number ___-- ------ Rock Filled Yes ❑ --� Rock Size --------------------•--- - Water Table Depth ------------------------------------------------ ------- ------- ------------------------------ Foundation ------------------- Prop. Line Distance to nearest: Well ____________________________ ` [ rR Date ---------------------------------- ------- ----------------- Septic ----- E REPAIR/ADDItION(Prev. Sanitation Permit s# -------------------------------------------- Se plc Tank (Specify Requirementsia__.________-- ___-. ------------------ ` ------- Disposal Field '(Specify Requirements) -------------------------- ---------------------- i ----- -------- -------------- ------- 3-- ---------------------------------------- - --- I ----------------------------------- F ---------------------- -------------- (Draw existing and required addition on reverse side) i I hereby certif th t I have prepare'd-thisn and that the work will be done in accordance with San Joaquin Y i:��, County Ordinance State Laws, and tRules and Regulations of the San Joaquin Local Health District. Home ownerr licen- I sed agents signature certifies the following:•-•4--- "I certify that in;the performance of the worlwfor which this permit is issued, I shall not employ any person in such manner as to become sub)et to Workman's Compensation la�vsof California.” �� ! 7"l -----} t OwneY Signed ------ f •� l - - - ------------------------ - -------- - -- --- (if other,than owner) [ t I FOR DEPARTMENT USE ONLY I i �.- PTe�� -- DATE _- 1A �:-�V- j---------------i------ DATE ----------- ----------------- APPLICATION ..__ PERM1715SUD i ------------------------------ BUILDING ------------------------- ADDITIONAL CbMMENT5 - - - ----- --- --- - __ _____________________ i 1. __-__ ______________________�_-_____ � j - __ _______________ _____- .__ _____________ - - - - Date - w Final Inspec i _ ; i v ' SAN JOAQUIN LOCAL HEALTH DISTRICT