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-- A-_ - ----.;! `w� � •; FOR OFFICE USE: �� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 179 1J•_ Permit No.......'-.- .-1 (Complete in Triplicate) „7 y Oeste Issued �lA-n -,/ - This Permit Expires 1 Year From Date esu ed ermit to construct and install the work herein described. r Ordinance No. 549 and existing Rules and Regulations: application is hereby made to the San Joaquin Local Health District for a.p - - lhis application is made in compliance with County CENSUS TRACT - i .:-�_J� 7•J-- -� _.Phone.-�-�_^� � - JOB ADDRESS/L CCATIO ..................... d..F . Owner's Nam City n _( f#C one -..----••------ ---•- -- - •- V• 5` v !' ` --.- Address �-yr _ .License # Ph =-------•- = Contractor's Nam _ Trailer Court ❑ ` 7— Residence ❑ Apartment k1At,cP l] Commercial ❑ installation will serve: Motel ❑ Otherjl,*' . e. ... ..... .............. , Garbage Grindw-Lot Size--,,)�. -(-... u . rooms__ .__ _w _Private C Number of living units:- �- Number afbed __.-- Water Supply: Public System:and.name---------- ---------------- Peat ❑ Sandy-Lock m ❑ Clay Loam❑ Cloy y e--- ---------------------------- g<Character of soli to a depth an feet- Sand-❑ S F 1❑Material-- ---- if es,type p ❑ Adobe faced on reverse side.) {Plot plan, showing size of lot, location of system in reidlion`itofwelis, buildings, etc."must be p , ,`; No septic tank or seepages pit per!"i"ed if public sewer is available within 200 feet,) �' NEW INSTALLATION: ( P p !�1.-----_-- ---------Liquid Depth---------------------t-- SEPTIC TANK I l Size? ,-Yi PACKAGE TREATMENT [ I _-_•,_.._No. Compartments..._.' - ' Ca ad /� TyP . Pro Line---••-•.:...........:..'.._. p tY Foundation-.- -•---------•------- Prop. to nearest: Wel ;._._ � /�/�:__.__,.,..............' __ � qc � ----.Total len th _&�1.- - - '^ -"I"t t 1 ._.Lent f each lins-_ ,:,,7cQ----•__---- � r _ - g� 4' rACHING LINE ( }. No.`of � " + (•---_....._.___._... D Box-_`�._- --TYPe Filter ateria�-------� -Depth Filter Matenal_.__._.- - h Q Por Property Line... d Distanceto nearest:Well. �_:_, -Fo'unation._. - Ye ❑ N 3Numbgr_ .�.t------------------ �ock Filled s SEEPAGE PIT ( ] Depth-----•-- Diameter_.__..:- } ...... Rock Size----------•-•---•••-- �' Water Table.fleFth. »n__.... Pro Line Distance to nearest:Well__+-------------•-rte F Foundation.....-_ --- .. ► �.......1--Date.............�._..:.-=----•-•---- - REPAIR/ADDITION (Prev!Sanitation Permit#----- - ��:4 , ; ................... •--....._. -----•----....._ . f --------'----•1. t---._.........= Septic Tank (Specify Requirements)------- --•_t:_...... _._!:._s--------------------------------------- Septic ---•-_- Disposal Field (Specify Requirements),_....:...... :. ---•--•....... .......... - - - ---- -- -- . ...•--•. -- .... -............. _ ... ^ (Draw existing and required addition on reverse side) _ ticafiort�and that the work will be done in accordance with San Joaquin County I hereby certify that 1 have prepared this aPP,., n Joa uin Local.Health-Distrect Home owner or licensed agents Ordinances, State laws, and Rules and Regat+o>n$ °{} ��s q - - signature certifies_ the following:----"" - t . to any person in such manner as I certify that in the performance of'the work for which this permit is issued, 1 shall not employ y to ecome t an' Compensation lays of Califomia:' pwn'er Signe ._. ....- - - - t •.--•• ................. - T' e - - 1 (If other than owner) FO DEP MENT USE ONLY' t DATE• '. "r ...� APPLICATION ACCEPTED BY •---- _.... -- -- DATE ..................:----------------••------:-- DIVISION OF LAND NUMBER ---- : - ..._ - --' ADDITIONAL COMMENTS-------------------------------------- •+ ..._.....--_..... ....... ................. _.._......_.....�.__....__. _ __.. __...:_..._._... - _. f65 21677REV 7176 9M Final Inspection•by:........ SAN JOAQUIN LOCAL HEALTH DISTRICT EK 13 24 V