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FOR OFFICE USE:. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No------------------------------------------------------ (Complete in Triplicate] --> �c', ate Issued.---- - --- ---- D -�� 7 This Permit Expires l Year From Date Issued ------------ ------ ------- I. t IM for a permit to construct and the Application is hereby made to the iSon ancewi Joaquin CouncylOrdantancUesNot549 and existing Rules and Regulations: work herein described. This application is made in comp �. ------CENSUS CENSUS TRACT."----- JOB ADDRESS/LOCATi // ' i / ! ------------------ ----------------- - hone --- ----=----- -- _---------- --- Owner's Name_ "--•-- -- -------- ' t ,... 14.e ._ : City �� .af�� V_ p Address---------`'-= _. �• # - M. w �`F,,' 7- -License #. -�r " -- -Phone Contractors Ndme _--�L(,)- � � -, I t ,• t-- J- ., I *. . ❑ ;Trailer Court Installation will'ser ve: Residence_` Apartment House. Commercial ❑ f t ` { M�-otel 0 Other_._'."' ""..'..-- - ------ ----=-- fIS € F . , g . Numberof livingunits:__.__._ �-.- 6f -._.Gar.b eGrinder_.._-__-".--Lot Size__" ----;.-��- -- to (� t Ej Supply Public System a�d name------ Water " ------------------------------------------------ 7 E riv -r. F Slit Clay. Peat ❑ *'Sandy Loam ❑ 'Clay Loam ❑ Character of soil to a depth ofI3 feet: Sand ❑ ❑ Y ❑.. l s Hardpan ❑ Adobe ' Fill Materia_.. _-. ._If yes,rtype-- - "--_ (Plot plan,showing size of lot„location of system in relation to wells, buddings,-etc, must be placed on reJerse side.) ��erm'itted'if public' sewer is available within 200 feet,) repticp PE AGE INSTATR ATMENT [(No SEPTIC TANK [ }ePage_.pit P Size ---==- =---- ------ -----'--- --=---- -=----- ----Liquid Depth-_--------------------- PA ----- ------- -----;- _T e._. }= = Miaterial--- -- ---------------`:-No. Compartments--._- t ------------------ .. Capacity=- ' � =' Yp k Line F ) �Mr .; Distance to nearest:.Well.:..----- = - = _ Foundation.-', = -.---.Prop. k .. y -Total Length--------------------- -- - LEACHING`LINE [,} �� Length of each line._ -_""-",,---- -- Na. of Lines Mate - -" -- --- --' - ---- — p Box_.:---------Type F�Iter. ria]------------------ Depth Filter Material., :-- --- to nearest: Well-. =------`-----Foundation -- ----------------- Property Line_ Y # Dist�nce Rock Filled Yes No I SEEPAGE PIT 1 1 Depth ---.Number--- ------- = —�; Rock Size--------------------- -------- Water Table De th.__ - --- - _ yam ------- ----- Foundation--=---------------------- Prop. Line_ Qistarice to"nearA't:Weil--s = Y---------- Ik. ,- Date - --------------- ---------- -----) -- REPAIR/ADDITION (Preva Sa'itatiorr Permit#___ ---- - ; P _ i - Se tic Tank,(S ecGf Requirementsnts _ � f__""-- '1&1( ` -c - ----- - ----- --------'-- p P Y1� % l Disposal FieSpecify �2e uireme } � ; + - ---- - ----- - - ' ------ �N = ___ --- = ---------- -=- -- (Draw existing and r.equ�re� addition-on reverse side) J ! 4 ^ I hereby certify that;;]have{prepared 'this application-and That the :work will be done in accordance with San Joaquin County Ordinances,j State Laws,'wind Rules and Regulations of'the San Joaquin Local Health District, Home owner or licensed agents signature certifies the folio Ing: not P employ any person in such manner as "I certify that in the perfor�since of the work for which this ermit is issued, 1 shall to become su i to Worlkm' 's Co ensatiors laws of California.'.' W _----- _ Pw �L -- ner g = Si ned__ ,,- r ... _, ...---.OTitle {I other than;owner) r tl MENT USE ONLY: i . DATE.471 1-777-- - F FOR'QEP.ART - _. APPLICATION ACCEPTED BY___ 'a► = = -------------------- - - ------------ - ------------ DAT ADDDIVIST100NOF LAND AL COMMENTS NR -- -- ------------ -= -- --- --------------- --------------- = = I : IM, ----- ------------------=----- ----------- ----,---------------- = - -1 ----- - - .----- ------- .1 , .. . . - -- -------- --- ------- Dat /_--- ----------- .-- � €�c!- e - - - - - ------------------------------------ - Final Inspection by:"""--". -=-" --�'� �- -- - _- - -- -=------ - - - - - - ras 21677 rev.7/7e snr EH 13 24 f SAN JOAQUIN LOCAL HEALTH DISTRICT I