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J FOR OFFICE USE: FOR OFFICE USEgppL1CATION FOR SANITATION PERMIT Permit(Complete in Triplicate) Date Issued_.(_ This Permit Expires 1 Year From Date issued and install the Application is hereby made to the San Joaquin Local Hdinanccestrict No. 549 and existing Rulfor a permit totes and Regulations: work herein described. This application is made in compliance withC�tY Q 7d7Z1_ CENSUS TRACT ------ ----------- JOB, --- - -- •---------- - --- JOBADDRESS/LOCATION - ° . ---- ---------------------------------- ---------- - -s tPh Phone i. ' y Owner shame_- ✓/ - � � -- -City z'P Address - Licese 747 one_. .. .�.. --�.-.-- - rn �. . Contractor's Name--- r Trailer Court ❑ artment House.❑ Commercial ❑ Installation will serve: `Residences., Ap 4, f i ! .3 X..- f Motel -Other--- ---- ---- --- - - -------------- 0_17 Number of living units:------1------.Number of bedrooms_.--,-,).--.-Garbage Grinde•r..._- . -__L.ot Size Private,( Water Supply: Public System and name--- -------=-- ------- ---- Clay Loam ❑ Character of soil.to a depth of 3 feet: Sand ❑ Silt ❑ .Clay F-1 Peat ❑ Sandy Loam y� Hardpan F-1s Adobe E] Fill MateraaL- ---------If Yes,#YPe - �` .. - . to (Plot plan, showing size of lot, location of system in relationerm t#edsifbugewer is available within 200 feet)de.) "- NEW NEW INSTALLATION: (No.septic tank)or seepage pit p , public ef �� Liquid Depth ------------- ------- SEPTIC TANK L�', Size----' -�- - PACKAGE TREATMENT C 1 t: ` t� terial- ko. Compartmen#s Capacity.) ---- Type------ � -- _ ou i Distance to nearest: Wel!__�C� ' -- . Fndation.---- -----------Prop. Line - No. of Lines: Length of-each line,.-------- ---------------------Total Length. LEACHWG LINE` [;� D' Box------------T a Filter Material ;< ' YP -`--- --=--- -`-`�,':-Depth Filter Material------ ------------ ----- ------------------------------ D' ---- ----- ----- -`----- -----� :.-Property Line --------------------------- -Foundation Distance to nearest: Well--------------- ----- --- ---- ------- p Y ' ---- - ^- --- ------Number----------------- - Rock Filled Yes ❑ 4 N°❑ SEEPAGE PIT L l Depth-- ---- Diameter_ »� Water Table Depth--------------------------------------------- Rock Size + i s Distance to nearest: Well--'- ----=------ --------- - Foundation ----------------------- Prop. Line k REPAIR/ADDITION (Pr on n Permit.#. a------------- ---------- ' _ Date 1 " =--- ----------- -------------------------------------- Septic Tank (Specify Requirements).-" -_--- � , ----------- -- ------------------------ ------------ ---------- --------- Disposal. Field {Specify Requirements)---F. --------------- ---- __ R ------- ------ -- ------------------- --------------- --- --------=----------------------- Draw existing and required addition on reverse side) application and that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared this app ' Ordinances,. State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed Lgents signature certifies the following: I p an person in such manner as "I certify that in the performance'of;the work.for which this Permit is issued, ;I shall not employ y laws.of California." to become subject to F Workman's..Compensation _ Owner E Signed_' - ---- --=------------- --------------- F- f ByE - ---- - ---- ------ Title L- 'llf-other'than owner) - ;. _ FOR'DEPARTM N USE ONLY -- -- APPLICATION ACCEPTED BY.'.. ---------- DIVISION OF LAND NUMBER ----- --- --- ------- -------------------------------- ------------- ---------•------ ADDlT10NAL COMMENTS ----- - - - -- ------------------------------------ r ' . _ _ -- r ---- ------------ ------------- - - .--- ------- - - -----------'----- - - --- - -T - " : Date - - ------- -- - --- - � Final inspection by:--------- -- - -- - F&S 21477 REV.7/76 3h Ex 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT