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FOR OFFICE USE: { APPLICATION FOR SANITATION PERMIT FOR OFFICE USE .. gyp � b (Complete m Triplicate) g . p p 1 No,7 �.� 1 Date`Iswed/D.3/ This Permit Expires t Year From Date Issued s Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herrstn described This application is made in compliance with Co/un'ty/Ordinance No, 549 and existing Rules and Requlations „ JOB ADDRESS/LOCATION.. .. �5 . . .�c+........S-Vii..... . .�/1^v iILTRACT 3� psxr jA �s !'Y x T "'F k Si i 4• � - ...- Owners Name .... .?fit- :.. .. .....•.... Phone eS �rs�3, , � CENSUS TR 4 / AddressCO 4 (,� .. .�iYF�+:.�:.` cr'�.Cc L v City.... Zapf: h4= ' Contractors Name. r d !L r]-�-.� L.............. .................License # /�5�3.9 Phone /(o Installation will.serve: Residence'' Apartment House ❑ Commercial ❑ Trailer Court ❑ ' Motel ❑ Other ... ................ ....... r Number of living anits ._:.'.....Number of bedrooms 3 Garbage Grinder .. L�Kr Water,5upply Public 5y tem and name..,,:.................................................:................. r`k �Priat fe , : Character of soil to a depth of 3 feet: Sand ❑ Siit❑. Clay G' Peat❑ Sandy Loam ❑ Clay Loam © , ` Hordpon ❑ Adobe� Fill Material.. .... ....If yes,type... #g a � 4. ,}Y IPlot plan, showing_size of lot, locotion of systom in relation to wells, buildings,etc.must ba placed on reverse side] '• vF i ,.. fi X11 ' NEW'INSTALLATIQN: .. (No septic tanl or seepage pit permitted if public sewer is available within 200•feet PACKAGE TREATMENT" ( $a x<� _ C T S. ...... .... ....... ] SEPTI TANK I 1 Liquid Depth4 Capacity....... ...-"..:......Type.... .... Material.......... . . .........:.No Compartments s . # 3 - .. _ 7 - T Distance to nearest: Well_ ..............Foundation ... Prop.": =' LEACHING LINE ( ] q No. of Lines .....................Length of each fins.......:_......... ...::Total length <' z N r s 'D' Box. ..-...... Type Filter Material....... ..... . ..Depth Filter Material:. M1J 4S 7 Distancato nearest: Well,.... ........... .. ..... ........... ....... ..Property Line SEEPAGE PIT; f ] Dep..i.. ...... . ...Diameter....................Number. .............................. Rock Filled Yes❑ No❑ , Water Table Depth............................................. ...........Rock Size..:. 4 Distcnce to nearest: Weil................ ..........................Foundation Prop.,line..; :r >5 REPAIR/ADDITION (Prey.Sanitation Permit#.........:......................... ...............Date....... ] f Septic Tank.iSpecify Requirements).......... ........ ..... ' ' ......-..._.. .. .. ...."---f .... F l Disposal Field (Specify Requirem,ents)" . ......................................................,.... ........,...................... ......_.......... ......... i _._ ..................... ........... ... ... .... .............................. ............,........_....................... ...... x {Draw existing and required addition an reverse sidel I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County, " s Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District:.Homeowner or liconsed agents signature certifies-the following: x "I certify that In the performance of the work for which this permit is issued, I shall not ernploy any person in such manner as` to becor� ub' tt to o�kmans Compensation laws of California." f r + Signed:. D.. ..:.. C . .. ,.... r .... .. .. .....Owner }} By :...... ) -r��.�,� 1°.�-;•,4sr�"-•....... . . ....Title ........... , G y I [itother than ownerr FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. til; DATE �... ... Q,c�-,.�_, c DIVISION OF LAND NUMBER-._ -. ....... ........ .. ..,......,..................- —......_..,....._.DATE f ADDITIONAL. COMMENTS.. ............. ........ .. ........... .. .•- ..:...... ... . ............. ... ..... ...- -:: 6- ............ - ... ., ... ................... ....... ........ ...................... - ' .............................- ..:- .. .. .. ..-_. ... .. . ....... .. - .. - ...... ........ Final Inspection by. . .. :........ / w ......... .................... .... ..Date:- E; 13 24 ✓ SAN JOAQUIN LOCAL HEALTH DISTRICT has pie» nE�3M