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FOR OFFICE USE: 'OR OFFICE USE: APPLICATION FOR SANITATION PERMIT 77 F67.4... ................_..._..___ ... _. . Permit No.. _. -_ _ (Complete in Triplicate) ..................................... . . Date Issued.'�-3:T ...... ........................_ .. . _. This Permit Expires 1 Year From Date Issued AI lication :s hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereindescrib ed. Th'ITapplication is made in compliance with County Ordinance No. �ElqJand exis g Rules and Regulations: JC' ADDRESS/LOCATION ` ,7 Q.V. G ?.LeS.. U - n.CA,12PO. CENSUS TRACT O`ffer's Name W19 `U/�..r�� %S0✓�_. M �N/3 . ..... _. . ..... . Phone_ _ ....... Address...... lzp.Ez �t�i. . `1'�L...IL'N�i�f'y,{}�L'�/�� ' ity..._.h rcl r�.i._.. .... . ........Zip ._.... C tractor's Name-r. ....1'..R/�KISN. t.�n.J,SnlrGA........License # .GS �!'C .Phone, s�iEr'�Q .... Ir�.011ation will serve: Residenee,K Apartment House❑ Commercial ❑ Trailer Court'❑ ' Motel ❑ Other......_..................._.... ._........ :V fiber of living units:..../........Number of bedroom ._.Garbage Grinder...... .. ..Lot Size...5.,/VC/,!E5.......................... Vr er Supply: Public System and name...._. ........ ... _ ........ ............... .............-Private ❑ Character of soil to a depth of 3 feet,' . Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam❑ Clay Loam❑ Hardpan ❑ Adobe❑ Fill Material.. .. __.If yes,type. .......____.._:::. (F,.j plan,showing size of lot, location of system in relation to wells, buildings,etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( P RAGE TREATMENT [ ] SEPTIIC�TANK�ppQ� D !,Size 5..�75..JRf ..__.............__....�......Liquid Depth_�S�i�.. ............ Capacity.�.G�.O.Q......Type 1.u.-` ..Motoriall.aril'rt,t.w_..No. Compartmenis.....l�.a� ._.... rr �6.../........... 0 Distance to nearest:Well..KJ. ....... ... __.............Fo ndat on_149................Prop. Line..... O L .CHING LINE KI No. oc Line ..... ....._....._.....Length.o�,f ea `�line...�.r..O. ..... .._._.Totlall Length ._I�-Q..� 'D' Box j.�ype Filter Materioh�' �. Depth Filter Material _!.e........_......._............_............_......' n Distance to nearest: Wel1.ds'...-/----.. . oundation..Z S.. ....__.....Property Line. ._..c�.�.....................y' — ' U nn ec rr �' Rock Filled Yes, No❑ S PAGE PIT bQ Depth cGy ._ .Diameter.s53 ..._ Number... ..._.. ... .... ... .. r C _ p / VI -. 3 u rr G Waxer Table Depth....0'S. 'F- , ---�� . ....Rock Sae .f� ._ ..- ... .... ... Distan4e to nearest:Well /� � _. ... .. Foundotion �. O_. .. ._. Prop Line___. ...... E 'AIR/ADDITION (Prey.Sanitation Permit k.... _............ .. __ . .....-.......Date.. ._. ..-. .... ... ......._. _..... ) ' \ r Sr,rtic Tank (Specify Requirements) Disposal Field (Specify Requirements). ._ _._. ._ .._ _.._._........_... )Draw existing and required addition on revere side) r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County, dinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents! :ynature certifies the fallowing: �(C "I certify that in tbpperformance of the work for which this permit is issued, I shall not employ any person in such manner as becosu jed to roma 's Co�rf%snsation Ip of California." / .3ne7. �r Q.S. 'f' erru.S /�(')�''`G.��dy � �4 , By...._..._. _.. __. .. 7 ` O Title (If other than owner( FOR DEPARTMENT USE ONLY _ DAT APPLICATION ACCEPTED BY - / G �I� DATE K-) nIVIS1ON OF LAND NUMBER - - DDITIONAL COMMENTS - --- - - - anal Inspection by: �j�-Tl � fv+-6� Do M -- 7. SAN JOr UIN LOCAL HEAL rH DISTRICT ns i1677 FFV.)q6 Ln