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FOR OFFICE USE: t APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: Permit -------- (Complete in Triplicate) q -------- ------------ Date Issued..e�;k -�-------- ----------- ----------- 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 describled. This application is made in compliance with County Ordinance No. 549 and existing and Regulations: CEN T ° SUS.TRACT ------ - -- a .. JOB ADDRfrSS/LOCATION___ .." �-_, -_. �— l �-�• ) --- -- --------Phone_5f _7 -------- Owner's Name ---�.r--�_�'�� /.�ff ----------------------------------------------- ------- --:- :- ��`S E. - -- --- - ---------- S f'/U T�/a.�� - -- _ Zip Y - = - , -License #. Phone_" Contractor's Name- -f'L� 1^G1LSC-- `~--- - = .t._ ., . Installation will serve: Residence's Apartment House.❑ Commercial ❑ Trailer Court ❑ M I .i.. . " : .� M6tel ❑ Other - --- ; E j Number of living units."_` .__ _-_- "plumber of bedrooms-._� ._Garbage Grinder. Lbt Size -""' -=.-- - ' t Pri "-� _ :,----------------- --` -e...- - Water Supply-., Pub[ lem anc-hams." ----=------ ------------------- at 'v e [�; i• f Character of soil to a depth of 3 feet: Sand ❑ :Silt❑ -Clay❑ Peat ❑ Sandy LoalnlJK Clay Loam ❑ ❑ Y type- - ' ' ------ Hardpan 1 } Adobe Fill Material_ _-lf es, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be,,placed on reverse side.) k r see a e it }erireitted if public sewer is available-kithiY 2OO_feef)—`"""^`�Fj NEW INSTALLATION: "(No septic tan .o p.g- -;p. .p.Size_""" _........Liquid Depth- ----- ------- ------- PACKAGE ---{-- PACKAGE TREATMENT" [']' SEPTIC TANK e capacityl ®�--- TYPe � atarial _ ---------- No. Compgrtmenis'... ` =------ Found at.ion.'"��_ __ :.Prop. Line x._.. . Distance to nearest: Well _- i r ------..Total Len' th LEACHING LINE [ } No...of Lines--_-3 - Length of each .line D. dam-pia -XD' Box-_/_--.-'--Type Filter Mater - _Property/Line __:-"" y---�^ { I r Distance toyriearest: We11 __._______"-_Foundation._ i J f Rock Filled Yes ❑ No I SEEPAGE PIT Depth."_ --- - --Diameter--------=------ ----Number- - " -----__ ze Water Table Depth ------------------------ --------------------------------- ------------------- Rock Si _------------------------------ 'Prop. � -- f ---- - distance to nearest: Well -----------------'-=--- --'------------Foundation----- --=------------ -Prop. Line 4 . REPAIR/ADDITION (Prev.-Sanitation-Permit#--------=---------- - - - --------Date---.L----------- -- ------------------ -- Septic Tank (Specify Requirements)--= ---- • - ---------------------------�-•-------- -----_-_------- , -------------�- : -------------------- -- Disposal Field (Specify Requirements ---- -- -- ------- ---------`----•-=-- -------------------------- 1 j - _ _ _.-. ---- ----- ---- G ------- ' --- - --------------------- - aw existing and req, erse hereby certify chat I have prepared this application and thatlred the work ll/bevdon side) a f. 1 e y y p p k will�be done in#accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of: tke San Joaquin.Local Health District, Home owner or licensed agent signature certifies the followings --ih-theerformonnce of we work Mol which this perrriit is iss d, I shall noteinploy any person in such manner as [ I certify'th�at t to became subject` 0 71irn `Compensation-laws CaliFornia.'.' +. + �'�- ----- - ------------- By -- ----- ~ .' ." Owner Signed � .. _ `= --- ----------=-------------------------------- [ BY -----"------ ------ = -•---- t T'tle 4. .61 I '(If other than'`owrier) FOR-DEP.ARTMENT USE ONLY,! Y t i 1---------' '- �'---------------- --DATE.: : _`''. - =- APPLICATION ACCEPTED BY_.__-.. ---r -- ----'----- ._ - ------ ----- f yA i / c- ..DATE DIVISION OF LAND NUMBER.--=------ ---- ----------------- .--- -------- -- COMMENTS 'r o V--- ---- ------- ADDITIONAL --------- - ------------------ -- -�, =y r # -r " ------ ----- - ----------------------- --------------- - --- ----------------------------- -----.�.-,- -- -------- ----- --------- �. � =_ t ---------------------------- ------------------- --------------------------- f / I �' - -)-- T T Final Inspection b --^ C ,'-4 ---------- Date.---- �--��--_- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&r5�2121677 REV. 7176 3 tom" -