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� - J R FOR OFFICE USE: FOR OFFICE USE: *• : ;5 APPLICATION FOR SANITATION PERMIT ---------------------- ---------- PeYmit N ;_--- 1-`�Z/ "" (Complete in Triplicate) ----------------- -------------------------- ------------ 1 �y� Date Issued.._l_-_�Q".7_ ---------------- ------------------------------- This Permit Expires I Year FrorriZate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB. ADDRESS/_LOCATIW_Z�---- I ._ i w ---- e. Phone Name • -- :- -- ®-- ----- --� y..-- -- ---- ---- --- j ---- --- Owner's1 Address :.. ��,,t. _ ---- Cit ip Y - 6 1 7 License # 1 '' i_ Phone------------ ----- Contractor's Name. Gh.��-'�€t - -� '4.if i Installation.will serve: ResidenceX Apartment House ❑ Corr�merclal ❑ Trailer-Court,rt❑ }; 1 ► j t Motel ❑ Other Y 4,Motel ------ - --- Number of living.units:. Number o bedrooms _-Garbag Grindar4" __Lot Size_...-. -a9 ''". . ------- -- --- -- r --- ----- -- -1 -Private Water Supply: Public System and name '" --`---------------- ----- -------- ------:: . - ❑ { t Character of soil to a depth of 3 feet: Sane[ El ;Silt El018y [E-, eat [-] Sandy Loam ❑ "Clay Loam 0 Hardpan El Adobe' Fill Materia,L_< ---- fi.If,Yes, tYPe----------t--� `--x--- -- --- F (Plot plan, showing size of lot, location of system in relation to wells, build:ings,..etc. must be placed 60. e e sideI t. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE`TREATMENT [ ] !"SEPTICITANK - -f:igvid-Depth.- ___ S CapacitAk . T pe Material_. _ No�Compartments-No: _ ---- ------I r f f, -7 r Distance;to r�arest: 11 e,1e, . [F�- ------ --.-.Tota Foundation_ __ __.___-______.Prop. Line_. _;__._.____.___f LEACHING LINE No..of Lines -____ //__ _ Length o each line.-- --- '----{,- .Tofial Length.:---- ----_------------- - J - __ �• 4 , 'D' Bo1__15V_.Type l=ilter Material_ - Depth Filter Material___ ``' "----------------- ' ; �...F �1 . t nem 1 G.l- Distance to nearest: Wel - '-=- Founddtion �`P,oper y, SEEPAGE PIT Depth ___.Diameter_: ` ✓Number-_.__ '�� i ; w. No ❑ Rock Size..,-- _ f ; a # ------- Water Table}Depth. ��-- --------- ---------- -------- -- -- "-- Rock Frlfe�d---Yes f � s fxr t /' _Foundation__-- 'Distonce to nearest:�lNeli_ � -- -- -------_:Pr p. Li e._--- '- - "---- - Prop. n a ----------- Date w""/S REPAIR/ADDITION (Prev. Sanitation Pbrmit#___I-_'_.7`�. _ ��--- ` 1Lt i h - z ---- ------------------ I Septic.Tank (Specify Requirements)-- = '`_� - -------------------==' ------ ----=--.---- -- yam;. � Disposal Field (Specify Requirements)-----;-- - -------------- -- -------- - - ---------------- - --- --=------ ---------------- � � ------ --- ::--------' ------------------ --- -------------- - = el -- -- ------ , ` i ' (Draw existing and required addition-on reverse side) ,-.r = I hereby certify that 1 have prepared;chis.application and that the work will be done in accordance with San Joaquin County V it 4i Ordinances, State Laws, and Rules .and Regulations of the San Joaquin local Health District. Home ownert or licensed agents signature certifies the following: ` t All "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 become subject to Workman's Compensation laws of Cali€arnia.' UARENCE'S SEPTIC & SEWER' SERVICE # , OSigne : Twitlener Ph:6"34-6S3o--Oro _. Stlekton,,Calif,r:-9:.5 : -BY c (If other thanlow er] F211 D RT ENT USE ONLY APPLICATION ACCEPTED BY.' - - �1_T._.--------------DATE ------ /©'-_) � -------- - ----- DIVISION OF LAND NUMBER.. - ----------------'------:----- ------=---- ----- _ -------------- ----------- ------=--- DATE.---DA ----------------------- ------- _ p ADDITIONAL COMMENTS- ------- -----f-.------------ ------------------------------------------------------------------------- ---- - ---- 01 -- i /l L - ------------------ c �o ' �• 7 IZ Date-7-7 - - - I 1 ----- -- - --------------------- ---- -- - - - ----------------------------------- ----------- �� - ate�7 / Z7Final Inspection be.. . -------- EH - EH ' 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7176 3M