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a I FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No. -- '-' )7 •+rd - -' (Complete in Triplicate) Data Issued v a .. .. . ...._ .. . . : This Permit Expires 1 year Pr`?l'uuad j' Application rz hereby madr. to the San Joaquin Luc 0- Heolrh E,,rricd for a permit to construct and install the work herein described. r This application is made in co*npliance with County CJrdmance No.S4J9 and existing Pules and Regulations: p ,r- 1 q+�! I>. st'I.0 NCN ��nn.? 'l�r�t. .. CEN Ph !J 5 TRA .... JOB ADDRESS/LOCAT,ON - 9 ,(�.�✓ one. 'S '>3 Owners Name. . _. s City/ Xe � �rr�l./� Lp�/ yt Address__.__ -ar ✓,/.1 _- - - - .} - j C s /„.._❑phone. . ..- .. .. _ . .�.h t�,t F'r +•`,rr. .r:- 4 I1-1 (1 . -.License #.._. . HG7 : k Contrcctor's Name . .. . . - Trailer Coort Instaliotion will serve: Residence Apartment House❑ Commercial❑ Motel.❑ Other _.. _ -_ - . .. e a _.. _... a. Number of Sedr:;ms, Garbage Lot S ze Number of living units: r - -- -. - Private _.. `-w Wistar Supply:Public System and name..._ - -- - - - - — CFaracler of soil to o depth of.3 Feet: Sand 0 Silt❑ Clay[] Peat[ Sandy Loam�J Clay L.om 3' Hardpan� -Adobe❑ Fill Motenol_�- If yes, —_ Plot pion, showing size of lot, la^aiion of system in relation to wells,buildings,etc.must be placed on reverse side.) NEW INSTAVATICIN: (No septic tank or seepage pit permitted if public seWor rg available wanm'qu Ofeet,) TA - L Depth 9 SEPTICTANK 17 Size. - - - - -N FACKAGE TREATN}XNT I t _ o Comportment _ - p .. ' ; Capodty.. .-. . . Type.. .. . .....Material.. . ..Y < —T-- . 5 .roundation-------- i . - .- .. Line... i Distance to nearest Well.. ... .. --- T ..._ . . Total Lengthrop .w: i No. of Unes..___ _ ._length of each line .. -. . .. ^s, LEACHiN(3 LINE f 1 De th Filter Material . - " " ° i! -- I 'D' Box._ ......Type Filter Material . . P . .. ._.. ' ... Foundation _. - - - Property Rxke .y . "Distnnce to r:earest:Well .- . ..Number. - --- SEEPAGE PIT I 1 Depth - . .__._.Dtcmeter . . F - . r 4e Rock Sae .-... .. Filled es❑ No Water Table Uepth- ...._. .. - ., Prop. Line .. _. ... ... ... Foundo!ion._ ... ... � .. ey Distance to necrestz Well - - _ �* is ,Date. .L . --- IR IRI�N (Prev.Sanitation Femti '� ............. )-'.. ..REPAmerits) � . " . � __ ../.- - -.... =e Tc Tank (Specify Requiremn Disposal Field (Spify Requirement eA ..... .. . p .. ., ........ {. - -...............- _. - _._. d "'" (Draw existing and r'yvired addition on reverse side),. '< y certify ths.t 1 have Preonred this opolicatlan c I hereby cor and that the work will be done in adance with San Jooquin CountyherebOrditionco, Stab Law•, and Rules and Regula6crs or the San Joaquin Local Health District, Home ov ,vr or licensed agents s signaI'M certifies the follcwing: 4Sks .. -,I certify that to the performan a of the work for whrsn this permit is issued, I shall not employ any person in such manner as a orkman's Compeasation low to become.sub'ect ;4 s of California.' .g J .. s" ...-. . r �Y............. ,• �1 J TI�— tea"'°'`; t • f a Signed ....Title .u.;. i c .... r , By-. . . . _ .. .� (If other than owribr) ,n FOR DEPARTMENT USE ONLY ------- -- '^ o �cc.c... lt[.f _ _ DATEIrn 7. . . tltl r. _.... ._.. ._ B y. y; APPLICATION ACCEP'ED dY �"`�v .�. .. . .. _ DATE ` DIVISION OF LAi4D NUAI6EP�^ v- _ ADDITIONAL 1%JMMENTS..Ir�. � . ... Dafq , iH 7./ u7 rx a-�. .. . r men s[v rna sr Final Inspect by- � io 24SAN JCAOUIN LCXAL HEALTH DISTRICT I e i •. ».g•[ j�?.'n.ZsaF'YN 9S�IL��°9..•`G�t:4a L' 3r