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FOR OFFICE USE: APPLICATION'FOR SANITATION PERMIT FOR OFFICE USE ------ I (Complete in Triplica"te)�....� Permit No..7.__._7�/ - -------- -- -A 1 1 a Date Issued-P--_�=._7I --------------------- ---------------------------- ------ This Permit Expires i Year From Date issued .N Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. t This application is made^in compliance with County Ordinance No. 549 and existing Rules and Regulations: x . JOB ADDRESS/f OCATION.._ G}+ Q �, ` ------- ---- .... .CEN Owner's Nam �� ht TRA . - - ---- --- --------------- • r = one:: Address_ P � =- -=:-- - ----- Contractor's Name. e�_� ' - --- -------- << h f c3i6_ v =�3 - License # _r.� ._ 'P o _y Installation will serve Residences Apartment House❑ Commercial ❑ Trailer Court ❑ � F F, Motel-❑—LOther. . ... . .- - ---- r E Number of.livrn units:__:_"-.. �_ ____Number.of bedrooms-'_ Garbagef i"LO I g Grinder. Lot Size--.,'-Z'9 �"`�---- 1--- ---------------= it Water Supply Public System and name--------------------------------- ------------- { t - .- - -- - --- Private Character of soil to a depth ofp3 peet: . Sand �� 'Silt❑ Clay ❑�r Peat❑ Sandy Loam Clay Loam ❑ � � Hard a ❑ Adobe:(-] . Fill Material____ -------If yes, type----------_:-----_----------- (Plot plan, showing size of lot, location of,system iweelation to wells, buildings, etc.must be placed on reverse side:i (No:'sep'itic tank NEW INSTALLATION: ' �or see .is. -y-( )able within •feetJ ' t I page"°pit permitted if public sewer7agwa+ PACKAGE TREATMENT [+] ; SERTIC TANK [,] Size--------------- . i P , I ;7 - - Liquid Det :_ Capacity- - TYPe-7� "Material :'No. Compartments--: = ' ------ ---------- Distance to nearest: * Well Founda tion-tl__=_.-_.,---------------Prop.rop. Lin LEACHING LINE: No, of Lines----------------- A ength of each __ ___.__:.".______ TotalLength fff 4 D' Box_-I--.__ .. Type Filter Material,__ _._._ ___.__Depth Filter Ma#enal ; Foun�dafion' Property Line- `t ----------- - 3 [ ] De #h_.-- -- __----Diameter.---- f Distance to nearest: Well----------------------------- ) SEEPAGE PIT � ,f �.." R �--------------------- : ------ . -- P Number--- -_- __- Rock Filled 4Yes ❑ No i Depth Rock Size.'---- .! :y D, tan eWater atb n ' serest: Well ' = -------- Y_1 te ----- ---- --- REPAIR/ADDITION (Prey. Sanitation Permit# :-: _`____________ ______ 1-7-Da °un ati --------- Prop, }ine� i Septic Tank (Specify Requirementil--------=->-------------- Prev. -=-----'--- - --- --- - ` --=-------- -- Disp (Specify quirem nts) = �-------------------------- ----------------- --G-.G - r - osal Field S ecif Re -------------------------------- ---------- ----------- -- - ---------------- r r - = --------------------- - - ----- -- ---- "- --- -------------- ---------- ---- ----=------------------------------------------------------------ _ ------- ,�. }' (Draw existing and required addition on reverse side) I hereby certify that 1 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 Joaquin Local Health District. Home owner or licensed agents signature certifies the followiFng: Ii 1 certify that in the performance of the work for which this permit is issued, I shall'no a ploy any person-in-'such manner as , to become subject to Workman!s Compensation law_ s" of California:". Signed"_: .-- ---------- - --' `- ' By ------------ - ---- (lf other than 'owner) .:- --.--Title---® ------------------------------------------------------ ---- - ------ FOR''DEPARTMEN' SE ONLY;=" ` APPLICATION ACCEPTED BY----- _'i_ :;-__---- r• -a - ---------- DATE = A � . DIVISION OF LAND NUMBER -- ---'h = ----- - = DATE-------- ----------------------------------ADDITIONAL COMMENTS--------- = ---------------------------------------------------------------- --- ---------- ----- - --- .--------------- ----- --------------�� d. ` --------------r------------=------- ------- ------------=------------ i 1 - - - Fina - -- - ---------l Inspection by:"__"_..-.A -� �. t EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fe 21677 REV. »>6 3M