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FOR OFFICE USE: �� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,�s _�__________�______ -------------------- ---------- __._____.._________ . Permit No_., .7_._7`ompleteinTrplcate]-.. ------------------- � -•-•----------------------------------------------------- This Permit Expires-,l Year,From Date Issued Date Issued- . 2— ssued- . 2— 2'7� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thew rk herein described. { This application-is-made in-compliance-with-County Ordinanc,A No-549 and ex stk g Rules-and-Reg-ulatiori"s- _' til f w�i JOB ADDRESS/_ -ANON_ Sa .---- Y__s_ 1�{-0_5 'x- { �`-�N�!!��._l�ic �CEN5U5 TRACT- i I 1. rr ,- - --------- Owner1 s Name. --------K.4Y_� ��'/C G - hone X3.9- -PP 3-3 ' _ _ ` Address 4a _ . _ Y�N G-` . t +Zip r I - - Contractor's Name . .9.�T/�o ns� f_=. Via( -: ----- _`--V; License #/65$6 Phoneme i y' --_ __-_. Installation will serve: i kgjd;�nc?TN Apartment Hlouse.❑, i Commercicil_C__Trakfer ourt A i ;. Motel ❑ ...Other "'¢ -- - t iGarba a_Grinde-r____k Lot: + g_� Size Number of.living units:_ C :______Number of.bedrooms___3_ � � Water Supply: PublicSystem and name.. --------------------'- ---- ---------- - ---------k----------L--------------- --- --------------------------------Private E] Character of,soiil,to a,depth of 3.feet. Sand ❑ Silt 0 Clay ED Peat El Sandy Loam W 'Clay Loam 0 vi, � Hardpan ❑ Adobe ❑ Fill Material--------. _If yes, type---_.__._s----_------------------ J (Plot plan, showing s1z"'of lot, location of system in relationto)w-fills, buildings,'etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage `pit permitted if public sewer is available within 200 feet,) ' PACKAGE TREATMENT i f .. �R r ` )..). .SEPTIC TANK [ )...: Size-----'- ---- ------------------------A---- ---------Liquid Depth.--------------- - Capacity. --Type---=-----------= --Material--=-----------------=--.-No`;Compartments— `� 3 Distanceto.nearest: Well---------------------- ----------==---- ----Foundation--------- ' -:..._::.--_Prop. Line-------------------- LEACHING LINE I ]. No. 'of Li'nes Length of each-I"ins -" Total .Length : ----------------------------F D' Box._?._.___.__Type Filter Material:._-__.__________Depth Filter Material__- _.___._ 8 r'y i Distance;jo nearest: Well----------------------# ---Foundation------------.----=----- ---Property Line-A.----------------------------_ i (SEEPAGE PIT -----.'-- -Diameter--------------------Nu mber--------------------------------- Rockf Filled Yes ❑ Noj � ) Depth # Water Table Depth = --------- ----------- - =------ ----------- Rock Size -- E lt. D.istance.to nearest:Udell ----------_________'"r_____..._._ --foundation.----- ------ ---_-.Prop Line.-------_----------- - 3 j N. 4REPAIR/ADDITION (Prey:Sanitation Permit#----------- -------------------------------- - Date---------------------------------------- ! ZSeptic Tank'(Specify r _ o_DI Requirements)------------=---.L-'--f-s-------/"-- -,- ------' _XIf- =S'�1l- = �y=3 TE'- , •f Zisposal Field (Specify &a 6 ------- - ------------------------------------ -------------------------------------------------------- - --- -------------------------------------- �1Draw existing and required addition on reverse side) I herebertify that I have prepared this application and thatthe-work-will-be-done-in•accor#ante with San Joaquin County Ordinances, State Laws; and Rules land Regulations of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "I certify that in the';performance of`the work for which this permit is issued, I shall not employ any person in .such manner as to become subject)o"Workman's Compensation;laws"of`California 7_ 'A +��___. �- I- Wim- --�- -•--, � � - ` 5igned---_ri. _ _.11rXrtY_ -- 1Y---- � -------- - -- --------Owner BYzC , � - p ---- --- ----------Title.---- ----------- ..--.-.---------------- _--.--=--------- ------ t If er'than owner) �4 FOR DEPARTMENT USE ONLY- # f APPLICATION ACCEPTED BY--:-- --------- ,��✓_ a----------- ----- - ----------DATE.-------- 7- DIVISION OF LAND NUMBER:--- --:---- ---------- Y_-t --------------------------------------- ------------DATE-'----------------- -- ADDITIONAL COMMENTS__________________Fi ------------------------------ ------- -------- -----------=-- --------------- : ---;-- ---- ----- --------- ,--------- _ - -- ------ ----------------------------- ------------- -- M f ______________________________ • ___ _ __________-_________________________ _ _______ ______ _- - - ___.___- Final Inspection,bY - - - --- - --------- -------------- ---------------------------- 'Date 7 r. = EH 13 241 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 776 see ,,