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♦. t, ' ' N r�y��' �� .�t 4y@(•�Ay �R�a"�f 4 '{y5f(+�w�F� C... FOR OFFICE USE I FOR OFFICE USE; " V APPLICATION FCR SANIYATION PERMIT �. ../ ♦ - I (Complete in Triplicate) Permit No,-75P 7 47 Dote Issued... :.a77y 's ..... . ...- I This Permit Expires 1 Year From Dab Issued Applicaticn is hereby made to the Scn Joaquin Local Health District for a permit to construct and install the work herein descnbed This application is made in compliance with Count; Ordinance No.549 and existing Rules and Regulations: i" JOB ADDRESS/LOCATION ..... Ow I s'20.............................CENSUS TRACT...... . Owner's Name 4q. . . .. U/}NRcs h-CUnn ... ... ..Phone 93.D-J�/6� Address.......S-At,-^-Q ... ..W-$ . .__ UV.L..., .. .... City. eSC LUr _.. Zip . .. ...__. Corhactor's Name_ U.LS(>.t'x_ ..........Tj 1i.Q*)o tL __. .. .License #.3.^.T.g.R.71. .Phone. �� olf �'yy c nn pp 4.. ... 43 Installation will se;3S SResiAnce nAua�ment HJ271� 04&r mercial p Troller Court ❑ 1 Motel ❑ Other. .. . ..... ... ._. ........................ GG Number of living units:..1...........Number of bedrooms--Z Garbage Grinder NO..Lot Size.......11 e lqtr.Gs_... . - Water Supply: Public System and name. .. ............... ...._.__....... ..__ .. ........................................... ...._ ................ ........Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Cloy❑ Peat❑ Sandy loam ❑ Clay Loam - Hardpan ❑ Adobe ❑ Fill Material . .... ... If yes,type........................ __.. . (Plot plan, showing size of lot, location of system in relation to wells, buildings,etc.must be placed o:i reverse side.) W NEW INSTAL;ATION: (No septic tank cr seepage pit�per-mitttedd if pubb ,) c sewer is available within 200 feet PACKAGE TREATMENT SEPTIC TANK .Typ--V ier1-11.MotwiL.................:.......No. Compo Liquid Capacity.... Depth. Distance to nearest: Well..........._........ ....__.. .._ ...Foundation....... .. . __. . .. Prop. Line............ _.. 31 LEACHING LINE ; ) No. of Lines . ... ...................length of each line......._.................._Total Length ._..... ..... ._.....-_.._ >: 'D' Box..._ . Type Filter Material . . .. Death Filter Material ......- ......._ ... , �. _.. C - Distance to nearest: Well .. .�R _._.Foundation—/0... 7'.e. . Property Line S .-.� ....._. SEEPAGE PIT I I Depth...... .. Diameter...... .. .. .Number. .. . ... ..... .. ....... Rock Filled Yes ❑ No WaterTable Depth............................... .........................Rock Size....... ..._ ... . ............................ i{ D.stonce to nearest: Well.............._..... _..... .........Foundation............... .... Prop. Line.........._ REPAIR/ADDITION (Prev. Sanitation Permit#................................... ._. ...—...Date............. . __......__....._ ..._....) Septic Tank (Specify Requirements) .. ..... ...... .. .. _. Disposal Feld Specify Requirements) - �� .. ,SQ.�. ! .�I ham... ... ... ._ (U� YJ A- .. .... ..... ..... ....... 3.X..3o.x. (Draw existing and required addition on reverse side) i hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, Siute Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licensed oq^nts signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to became subject to Workman's Compensation laws of California." Signed1-.(S,0 Y--:�.....1J%l��i til0 C. . ..Owner By . ..... j.�YA1-Y. ...C1 .. .__ .. .... Title.. Coy-%Tf6 U01I^.... ...... ... . .. (If other than owner) FOR DEPART _NT USE ONLY _ .4PPLIC yT:ON ACCEPTED BY. .. 7. _..__ .. . . .. .DATE 2 DIVISION OF LAND NUMBER ... .. . . _. /._ .. DATE ADDITIONAL COMMENTS .. .. .... . _ .. ..... ....._. _. . . ..... . . .. .......... .._ _ . . _ .. _.. .. .7f� Finai InspecTion by. _. . �� __ Dotef Ex a 24 SA JOA IN LOCAL HEALTH DISTRICT res 2(kEl >in