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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit No._ 5--.L?6qu- "-•----------------------- --------------------------- This Permit Expires ! Year From Date Issued Date Issued.-7=,-?-2f)- 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: �. _ ,-__--�_ _ __-e57 T f--�- - -- ��.O� ADDRESS/LOCATION.. .CENSUS T C7 Owner's Name--- --------- r lf =-�oG.lr - _ ----------------- ------------ - Address /,'/ d1/7 e i -�f45-- city _. / etd p -`53-3. . --n-----Zi - _ r • - - -- -- -�-� �.�% -- ------- -=------- ------Licerj�e �`�Z�3.36� Phone.�a_7-�_�_� Contractors Name___ __ • -�1.�1� Installation will serve: Residence -ffi, Apartment House❑T Commercial ❑ Trailer Court ❑ Motel Other Number of living units:-_-_•_ Nurrmber.of bedrooms:__ - �--- age Grinder------------Lof Size -- i Water Supply: Public System and name-------------------- ------ 7-,'j.� Pr v -------- , ar `------------------------ ----- -- : Character of soil to a depth of 3 feet: Sand I t '. — _--- at = ]. Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ `` ` Hardpan ❑ Adobe.❑ Fill Material--__ ------If yes, type-----------------y an, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) " NEW STALLATION: :(.No septic tarik or seepage . it m � . p perrritted if public sewer is available within 200 feet,} PACKAGE TREATMENT, [ ] ' SEPTIC TANK - - ' rlr I Size Z7 -• --- Liquid DepthT - `--".- b� :.. I ,. Capacity:•-_._. TYpe1 41 I _ -- ---Material ;---------------No!}} Compartments--------I----- Distance to nearest: Well.._ � 1 Foundation----- 1___,-- :--Prop. Line i__-�-- �� =--•-- ----------- LEACHING LINE [ J .. No, of dines.- ) - ----- --- Len gth of each line---7-40 i r ; - # - ---------Total Length -.�-.f_.oL-- ---- -------Type Filter .kDepth Filter Material—'] D' Box--;-_f-.---7 e Filter Material:1/2 i,t►' I. . --;------. r:. -------- s Distance to nearest:Well-_--1_ Y's_-Foundation".- -._--_------;___----- property Line= ______ SEEPAGE PIT 3 µ , .; .._.: „ ----------------- 1 . Water Table De th - Number i Roc [ ] be th-__. --_ _ Diameter_; k� N p . _ F Filled I ---Rock Size-------4 -=------------------ } ❑ o I : { Distance to nearest:Weil.------------------- - --- Foul,dation----------=------------I.Prop. Line-!------- AIR/ADDITION (Prev. Sanitation-Permit#-- :-_._ % I - i --------- ---== ----- ------.Date - = - � Septic Tank (Specify Requirements).- �cC�C'a.__ - ----.--- -- Disposal Field (Specify Requirements);..- ._-t______ Qit - .--- . 7 ------------------- ---------------------------- ------------- --- -------------------- ------------- " g ------- ------------- ---------`-------'- - - --- (Draw existin and required addit addition or1�" verse side) I ��t � I hereby certify that'1 have prepared this application and that the 'work will`..done°--in,�.ciccor�ance th—San Joaquin Coun Ordinances, ( ty State Laws, and Rules and Regu#a:tions of the Sa kitrcC.uin Local Health Districk`i,Home,owner or'licensed age; signature certifies the following: — � ri "1 certify that in'the _ �� } performance of the'work for which'this permit is issued,11 shall not employ any person-:in such manner as to become subject ,ta Workm n's Compe .laws of California." --- � . I . [/ Signed-- - � ----------Owner , BY ----- V? (L ;• Title ---------- ------ �• •- - ---------- ----- ' , f other fhanowner) --. - . - , . " f•.- :fOR'DEPARTMENT USE�ONLY ' . _. . . ' <. APPLICATION ACCEPTED' BY__-____.. -- -- -- . DIVISION OF,LAND NUMBER. ---------- DA ---------------- = -- =------------------------ DATE. ADDITIONAL COMMENTS--- --------- ----- : --------------------= ------------------ -------------------4---------------------------------------------------------------------------------- ----- -------------------------- p - -------- --- ---- -------------------------------- ------------------------------- -------- Final Ins ection b ' Y _ - = - _ --------- ------------ _ ---- ` Date-"_' - ------- ------------------------------ -- - EH 13 24 ----��--- ----- SAN JOAQUIN LOCAL HELTH DISTRICT fas - 7176 3M