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.. FOR OFFICE USE: JOR•CirFICE USE: APPLICATION FOR SANITATION PERMIT LDcaite t No.79___ -------------------------------------------- (Complete in Triplicate) Issued-1D-�--1_711 This Permit Expires 1 Year From Date Issued ------- --------------------- - - i trict for a mit to ruct and install the Sawitli�Cou�tylOrdpntancDesNo.549 a pd exist ng Ruand Regulations work herein described. Application is hereby made to the This application is made in compliance � 4,. r„�,_•�„T_�,. CENSUSTRACT------ ----------------------- - -_--_-_ t r ' . �_ ;_. C �._.. - ._Phone__ wJOB ADDRESS/LOCATION ,----_• -- --- �._�� ------ - Owner'sName.-- -- - - __vt'/!!1 - ---- - --------- -------------City Zip----- Address------- _ hone ------ -- --- -- . e se Contractor's Name-------- ---- s .3r :'. ;; w : ' - Residence Ap3 tment Nouse❑ Commercial Trailer Court ❑ Installation will serve: _ Motel ❑ Oth'er_ __ -_ ------- .t -----,:j,y�r } - .�. I ------ Number.of living units:_-__-/- -_ Number of.bedrooms_,-r__ arba.ge Grinder-- Lot Size--- r t _ r s -__Private El Water Supply: Public Systemand.name----------- Ch” _- '.--_ Sand Loam Clay Loam ❑ Silt Cloy Peat 0 Y ❑ ' Character of soil tola depth of,3 feet: Sand:❑ ❑ - • _Y ❑---- - P 44-Adobe Fill I111aterial if yes, type-- --Hard"an-❑ � ' (Plot plan, showing size.af lot,- 6t tion of system in relation to wells, buildings, etc.must be placed on reverse side.) i... : . NEW ANSTALLATION: _•!(Nd, ep•?t c tank _or seepage".pit permitted if public sewer is available within 200 feet,] 4 PACKAGE TREATMENT [p-I SEPT44ANK [ ] _ : Size------------------ -'----- ------ -- Liquid Depth. -- Mat�rial_. ` == '" No. Compartments.- ^'-=-- --- ''' ------- -capacity -----------=:Type = - , '�.-i :Distance t nearest: Well------- ------ ---- .------- Foundation.. Pro Line` . I .k. ------_Tota --------- ------- --- ( LEACHING LINE; [ ], No. of L'Ines- .--_--.----.--- ..Len-gth of each line.-:. = Material Length - 1 t l __ ___-Depth th Filter Mater" � ti Type Filter Material_. __ -- -- per; r ------ I -- Foundation: ,� �,arOperty�-� L.re � Distance to'nearest: WeIL_.-- --- ------ --- >,._.. . :.....:. •-•--• Number-------------------------------- -----Diameter- SEEPAGE Filled'lied rY � 01❑ -- ,^ e N ' ` SEEPAGE PIT [ ] . p :-- } Diameter. be - - De Depth c -- - -Ro k Size _ L i _ - � Water Table De th-- --- --- ----- -- - p n a - n -- me ._ ' I } Distance to'nearest:Well-*.. ------------------ REPAIR/ADDITION -- --- - ' Fou ddo - rop L -- ='--------------------. .: . . �,.-•-�Date�..�;,:._.�:.---Tom.:_: -._.-r ------1 l REPAIR/ADDITION (Prev Sanitation jPermit# -- "`i . _ - - -- Septic Tank (Specify.Requirements]--- -- --------- -------------------------------------------- - - '�. I Disposal Field (Specify'lRequirements} _. i,i f 1 - -- .----- ---------------- x _._ [ ----•- - P-. __ - -------- ------"_---- •-- - F- --- -- -- k - ---- _ (Drawexisting and required addition tion on reverse side) ( the work will be done in accordance w with S�/JQaquin County 1 hereby certify that•1 have prepared this application and that l ; I Local Health'District'`Horr►e owner or licensed agents_* ? Ordinances, State Laws' and Rules and Regulations of the San Joaquin I signature certifies the following: i -` erson in such manner as -'` .._ "I certify that in the perforMance of'the :work for which this ped mit is issued, :I shall riot employ any:p to become subject, to 1Workinan.s .Compensation;laws of Calif€rnia 'j_ E. i 1 ! g "� r - weL �= ------------ Si ned_ - T -_ __ __. t ... til - ( other Phan`owner} rs OR- EPARTMEN US ON ----------------- Y' -- -T - - -- DATE - APPLICATION ACCEPTED BY _: /�� ' .-----------Y A -- - - ------ :. DATE ; ' '-- -- - DIVISION OF LAND NUMBER �; . {- . - -- COMMENTS _ = ---------------------- -------------- ADDITIONAL ---------: ---- ------------- = -------------------- ------ t '--Date---SOLO ---- pdte FinalInspection by: -� r&s 21677 REV. 7n6 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT