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USE: FOR OFFICE USE: FOR OFFICE APPLICATION FOR SANITATION PERMIT - Permit No:. -3 r ------------------------------------------ (Complete in Triplicate) ------ --------- -------- P Date issued---- -1-- -- -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. pliance with County Ordinance No.T549 and existing Rules�and`Regulations: This application is made in corn JOB ADDRESS/LOCATION .. _,. - - rNSUS TR[?,C ,- 4 = Phone -. - - -------------- --Owner's Name-------_- _ - ---- P o Address - --- -- - - _ _ -- ---- C'ty _ sp _ .__ tens ` Installdtion will serve: Residence Apartment ❑ cia ❑ Trailer Court ❑ Contractor's -yName._-_-- -- _ 2 - ; i . 1 t House , Commer - Motel ❑ --� Other I Other_ "- ------------ Grinr = LotSize---- -- ----------f --- ---•----------- ivng units;__--_',/` bedroons'_;;;)_ - _Garbage Number of Water Su I y Public System and name -----;-- ----------------------- Character of oil to a depth of 3 feet: Sand El 'Silt E] Clay ❑ Peat 0 Sandy Loam [I Clay Loam .. . Hardpan ❑ Adobe ❑ ' Fill.Material_-----------lf Yes, type---=------------=------=---- - - Piot Il n showing size'of lot, location of system in relation to wells, buildings, etc, must be placed on reverie side.) ( pi NEW INSTALWION:- (No"septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT- [ 1 ,-SEf'FI T� K_ -1-=$ Size - Liquid gepth �-" Ca cit __. e ---Material----------------- "No.-Compartments--: Pq� Yo -= -.Prop. Lin 1'l` , D Stcint ;;o_nearest F undo P o e 4 p j I 1 No.,o � r ------------------------- eVs 9_ :- ------------.Length of each lino---.- - Total Length LEACHIN01LINE [°l, I --------- �� `D' Box.----------Type Filter Material------- -------Depth ,}Iter terl I - �... ..o ...- R �.... i - Foundatlon. k� -- .---.Property Line Ill e: No s � [ -Dis�nceto nearest: Well ; -- - _ �-_ _y ` Rock De th Diameter - ---Number /' .-.w_t ❑ Roc ed Y s. SEEPAGE PIT I l orp. ---- i a dater Table Depth _ = - - -------- Ro Size: fl ( 1 ; T f Foundation --_---- --- Prop Llne _ Distance to nearest: VIJe�If -- •, ix... . REPAIR;/ADDITION (Prey: Sanitation Permit#_--_`-�`--- =- =--=--- -----"- I -- _ = f Date------------1--------- -----------------F------------------ C� L / f -- --� ----;, ------ Septic ank,(Speclfy ec ulrements)___.--.---- f ,A i 0 Disposa} l Field (Specdy Requirements):.___ _1*�. : ��✓13.E l i --- _ ---- _ 1?Iii " --} - - --- I ' I r__ __.-___ /�___ _ _ ___________________1'___ .._C._-- _._-.--_._.__.___ s_ 1._-_-._____- -__ .._---.__r.__ _____________p._.___ _ � ��y -------- --- ----- ` i (Draw,existing and�q�lire add�tion on revere side) ` 41 I hereb certify that I have prepared hip application-and that:the v' o k will-be donee accordance with San 1 oaquin County Ordinancesi�Stgte La} sl, and Rules and Regulations of,fhe San ob�aquin Local HealtlVDiltrict, Home owner'ori licensed agents signature eertiFies the'folsswin � y y� ^,p 3 „ I " '" lk erti tl dt m the e � e ha )v rk for which thi's per ni is issued, l she I not employ any person n such manner.as to beco'm �u6ject to ork en'rsCA!r1 ensation laws of. California." 11 � 7,ln G� - l - r . i Signed-,- r% --- Owne - - R . t -1 `Title---- ------------- �t ------- (k other than owner) FOR DEPART_ME T USE ONLY DATE. APPLICATION IP,CCEP E BY__ _ _ --- -- ------ - � DATE---- --------- ------ --- --- -- -- -- "- DIVIS16N OF LAND N ABER.------ "------ - - -- --------- ------------- ----- --------- A-DDlT1ONA1 CO-WMENT ---------------------------- --- -- ------------------------------------- 1 - - r- Y e - - y _ --------------------- -------------- ------ - - ------------ - -- - _ _ _ ------- -------- -------- -------- -- --� ate_..' - ---- ---- - ----- Final.Inspection-by: ------ - F&5 21677 REV, 7/78 3M „ K 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT P