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FWOFFICE USE: FOR OFFICE USE: T APPLICATION FOR SANITATION PERMIT t -------------- fes»• - (Complete in Triplicate) Permit No._7.��-7-1- -------------- _-- = ------------- t _*ew /01' Date Issued._/.-,3//- � ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued .:4Application is'hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. w This application is made in compliance with County Ordinance No.549 andel existing Rules and Regulations: JOS ADDRESS/LOCATION-- �----- --- - ----- -. - � - ------- ��c-- - CENSUS TRACT----------------- ------- r Name.'��_.'rC-d)-f T �5 S U � �-� -------------------- Owner'sI �. _'fir Phone 15499Af ------- C Address - i ..--; -- Y � P. t Contractor's Name �!/d`/ 1�--- --- ---•------------------------- License #. .. ../ 3 Phorie__ 3®.J Installation-will serve: Residence [�: Apartment House.5 Commercial E] Trailer Court Q a r Motel ❑- rOther---- --------------------------------- P ,, Y F9 Iy =rte- i 'Number of living units:-- _�:l_ Number of-bedrooms--� y _-.._____=_Loti.Size-- -- -_... __..___.___--- ._ Garbage Gander Water Supply: Public System'and:name----. -` -- -- --- _- T _- Pri ate T Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy L m ❑ Clay"Loam ❑ 1 Hardpan E] ; 'Adobe,❑ F ..."-:- iii Material,__- --If yes, type-------------------.'��" i r l (Plot plan, showing size of lot, location of system in relation to wells, buildings,#etc, must.Ce placed on reverse side.) NEW INSTALLATION:" (No septic tank -or seepage pit permitted if public_sewe is available within 200 feet,) PACKAGE TREATMENT-[-] SEPTIC TANK' "] Size.- ' - -------- Liquid Depth.-------.------ ----4- ` No. Compartments----�' _ .o.... Capacity/Agp Type'--,, ---s-----------Materia --------- ----------- ��-------------a ap Distance'to nearest: Well---15 ---- ------ ----F_ou�ndation..---- r---------Prop. Line--------------- ------ LEACHING LINE (j _. No...of Lines_ _._-__ --"-..,-_-,-_�_..Length of ach.Iin&_......---. >-- -Notal Length------- _. _ _ -- t- tel --4 � , r i Box----I------Type Filter Material./��D.epth Fil er Material -------------------------------------------------------- :'D' a t f Foundation i_: _ .______ _Pro Property Line... Distance to nearest: Well •--f--_--- : '•- p tY l ` --- SEEPAGE PIT [ ] Depth----------------Diameter----------------_----Number-"-."_-."_______F_____________i_ i ' Rock Filled Yes ❑ No ❑ T. - � " ; � Water Table Depth-------------------------- ----- - f ------------.hoc S �anon__,_.___�. •- --------.Prop. Line.. -----------'------�- -- REPAIR/ADDITION (Prev. Sanitation Permit#------------ ----__._--- .--: ------ Date___._..._--1.--__ ) k Distance to nearest: Well________________________ oun Septic Tank (Specify Requirements) - ------ 1 - ` - ---- ------- ----- - --- ------ Disposal Field (Specify Requirements) ------------ - ------F►--r--Lr- ~---_. --- -- - ------ ----------- - t -- -- - - ----------- G _ '�-'�' f {Dray✓ existing cpnd required addition on reverse side) ' I' I hereby certify that 1 have prepared this application and that the work will be done in accordance-With San Joaquin County Ordinances, State Laws, and Rules and Regulations of thwSan Joaquin LocalHealthDistrict, Home owner or licensed agents signature certifies the following: ; ' "I certify that in the performance of the work for which this permitlis issued,11 shall notemploy any person in such manner as to becom iec to . ork m an' Compensdtioa laws of C ifornia." ' t Signed.- '------ 2- F By-' - -------------"Title- --------------- ------------------ -------------- ------- --- t (if other than owner) P FOR DEPARTMENT USE ONLY -- DATE iAPPLICATION ACCEPTED BY__1::::!C1------- DIVISION OF LAND NUMBER--------- ------------------------ -----------_---:- ::; " -.-.-.--DATE--.- ------------- --------------- ----- --- --= F ADDITIONAL COMMENTS---------------------------------- --- - r s --------------------------=------ -----------------•---- =----- ---------------------- -- ---------------------------------- ---------- ---------- ----- _ --------------------------------- - - ----- - ------------------------------------ - �} Final Inspection b �..a. .. "---------=------------ Date-.-,._ C Ex 13 24 SAI\T,1@f[QUIN LOCAL HEALTH DISTRICT F&5 21fi77 REV. 7/7fi 3M