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{ FOR OFFICE USE: FOR GFFICE USE: . r-APPIATION FOR SANITATION PERMIT ------------------ --------- ! y Permit No.--7 7` ------- {Complete-in Triplicate} - ----------- Date Issued-.1" ---------------------------------__ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local He'IthCDist ct for a permit to construct and install the work herein described. -This application is made in compliance with Count. -Ordinance No. 549 and'existing Rules and Regulations: f„ f/ ' ' EN SU S.TRACT/ (.O. s �'e--/ NL " `JOB ADDRESS/ Owner's Name Q_ ._ -r -- �-----a. . . -s _ .. Phone ��_.. -------------- ed .-. ' '-:c,ty ---------- License °?�,'2('-tej7- Zip _ ------- Address ----- 776- -- --- - € z� i nse Phone! -------- -- ------- q(�. ti+ 43 2I i� e2 :A Li # ---- --- -- � Contractor's Name--. Pha Installation will serve: s Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel r Other----------------IJ =`_--" .-'---- --- ��/�� R f ' st -� ------ - Number of living units:_--/.-" - '��___-Garbage Grin Number.of bedroo Private 1 Water Supply- Public System land name_Sand 5il --- ----- --- Character of soil to a depth of 3 feet: ❑ t�l� Clay ❑ Peat ❑ Sandy LoaVf m ❑ tCl Loam t 'Hardpan Adobe Fill Material If es, type --- --------------- . f (Plot plan, showing size of lot, location of syste� in relation to wells, buil dings,.etc, .must be placed on revere side.) NEW INSTALLATION: "r(No septic tank or seepage .pit permitted if public sewer is,available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size f____ �� ------------ -- --Liquid Depth._�� ._.______ +. cap e.1.2�- ----Moteria _ ------ Cor2lpartments-----!�.�------------- --------- P Y-1= �Q p , -�— 1 c� 4 ------ -. r ' - Prop. Line Distance to. nearest:fWell ---------------- 101 ` � _�� _._- - Foun ation-- Q --------- c K'lEACHING LINE, No. of„L+ne T e Filter Material__ __ __ _ _ De,�tli Filter Material Total Length ._____._. _.._._ __ th of eac line:_ „ .a -� P = Yp, o'D'�Box_ �P I ' Well _ © _� _-Foundaton .,_.Pro Property Line------.Distancto.nearest: Deptl __ 3 Diameter_��_ --Number-----4e ---:---- '-- N SEEPAGE PIT _ R Filled Qk Yes' o �-^ 4 SL'- Water 7alble,D th- - d-- r } ---.Rock Size----- -- ------ ' ` `' ----= Pro .e Distance to nearest: Well-'-t c -"-'� ---------=------Foundation--.=- --- -- p. Line_.----- _------2____-- REPAIR/ADDITION (Prev. Sanitation Permit#-___.:___-..__--- -” - - • Date--- ------- --------- -- ----� I c � _ ' Septic Tank 5 ecif 'Re uirements) --------- -------------------- -------------------------------- ----------�-- --- --- --------------- Di posal. Field (Specify Requirements)-------`- ------------ ----- ------------------- ------------------------------------•-- '--- -- ---- -- --------------- ( j .A - ---------------------------------- -------- - -- --- . --- ------ ------ - . r 44 ------------- - -------------------- - i ' (Draw existing and required addition on reverse side) " I hereby certify that I have prepared this application and that the work will be done in accordance with San 'Joaquin County, Ordinances,: State Laws, land .Rules .andi.Regulations of the San _Joaquin Local Health District, Home owner or licensed agents 1 signature certifies the following'' 1 . "I certify that in the perfor ie of the work'for which this permit is issued, l shall not employ any person in such manner as to beco ject .t War r Compensation of Calif rnia.." , Signed `�_.��_ <�f��--- ------- --- ----"EW.--X-YT �' Owner � � •� - - --- itle._ �?. /:'By_.___--__. ____(If other than ow ' '--- "`FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED+BY" `------------------------.----------.-.._-- -------------- :------=---DATE -- 'T"- ~-- -- PT - DIVISIONOF LAND NUMBS :---- t----------------------------------------------------------- --------- ------------ ----DATE ------= - --- ----------------- -------- ADDITIONAL -- - ADDITIQNAL MENTS-----= :'I I _ �s�a.- ------------ �AL ;► r,W-_ c .41 -a. _ _, D 3"-""_-- ..----- -- __------- -------_}--=. -�__ "__ ate..._ �3 �_Fina[ Inspection by=----- ------- ------=---------- ------------ : ras sibrr R ( 1 snn. EH l3 24 rSAN JOAQUIN LOCAL HEALTH DISTRICT