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FOR OFFICE USE: �^ G,� �u b z 5_e 9az3�'-f'u 3 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --3 (Complete in Triplicate} Permit No... 7i ______ ____ _______ ----------------- ------ ---------- Date Issued-.el___44-7� •----------------------------------------------------- -- This Permit Expires ii Year Fro Date Issued 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: JOB ADDRESS/LOCATION. .- - �- - S ------ _--- -- ------' d ------ -----CENSUS TRACT--------------- Owner's Addres#s_Name.- �3. . - ;.1' ..l d" •� :--- Phone_ � � - City__,� c��.0------- zip ------------------------------- Contractor's ------------- Installation ---- 'License --Phone _ .�,� -._. 4 A artment Nouse Commercial Trailer Court, ❑ : .------= lnstalfation will serve: Residen �: p ❑ ❑ a NumbMotel ❑ Other r g i ---- "o � Garbci e.Grindar_.- i # Number of livin' units:___ r.of.bedroams_ g Lot-Size___.-_ _____- - F ff Water Supply: Public System and name---------------------- ----------------------------------------------- ----- -: --------- Pr t - - Iva e� i Character of soil to a depth of 3 feet; Sand C] .Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam 0 Hard an . Fill Material._.__ P ❑ Adobe.0 � ---If yes, type --------•------- - =-----•'_ It a (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1 NEW INSTALLATION:' F(No'"septic tank or seepage pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT--[- ] SEPTIC TANK- [.]._ ;' -,' Size---- --- -------------------------- i Depth-'-----' 1 L'quid Depth Ca acit ---- -Material----------------------:__No. Compartments-- ------ _ P Y Type --------- -- ;. .. Distance-to nearest: Well=------ ..,.,,---- - ---„__Foundation -_------5- '------a.-Prop. Line '- =; LEACHING LINE: [ ] No. 'of Lines_..._..____-________________Length of each line-------------- _,--------------.Total Length.--__-�----- -- ,____._ t 'Q' Box_ ”-..._.__Type".Filter Material--------------------Depth Filter Material__.------�__ . _. -. -._'_. I------------------------------------------ --_--- Distance:to nearest: Well_ _,__ ___ -- s_.__.Foundation___. ---- Property Line N SEEPAGE PIT [ ] De th____;_.___;____Diameter_______________ __ Number___ r":_L_._-._____-_:- p, ----- _ Rock Filled Yes ❑ Nas❑ Water Table:Depth = - -:Rock Size-------=---------------'- . Distance to nearest:V1/e11_ ------------- :Foundation --------------;Foundation------- ' �--- ------- Pro . Line --------. -- (CO REPAIR/ADDITION (Prev.,Sanitation-Permit Dot - --- --= --- ) 1 5eptirbank (Specify Requirements) ---------------- ---------------- Z_ -------------- ;. ------ ---- ----- . Disposal Field (Specify Requirements):-- ------ ----- 921___--___-_---.�/--- - ----- - ---- _ : .. ` -- ---- ----------- t --- --------- ---- - . R - ----------- ----------------------- ------- ------ - --- # ! Vaw existing and required addition on reverse side)� ,,� IZ_J1' I hereby-certify that.l have-prep` red this-'application and that the work will �`e�o a maccdrdan a .with San 'Joaquin County ' Ordinances,- State Laws, and Rules and Regulations of the San Joaquin Local H_ ealth,6istrict, Home'owner or licensed'4rgents f =signature certifies the following: .5 "I certify that in the performance of tke'work for which this permit is issued, I shall notCemploy]any.-person in such manner as 's Compensation laws of Ca ,, ' 'to :become sub' ct to rkrr} p California." .. � �I_ t Signed)----- - - --10: v _ # �- . - -_-----------------Owner , }. � . ( --------_ Title I By � If other than :owner) "'=f�� ? 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. -- ------ _ ---___-- _-- DIVISION OF LAND NUMBER________________ -- __. DA1T ADDITIONAL COMMENTS------------_ ._ - ------------------------------ ------------=------------------ • _: Z = -- --------- ---------------- - ---------------------------- ------------=------------`-------------- --------- ----------------------- 1 'n`Final.;Inspection-by:--`------- .x - - -- -_ �! -----------------------------------------------------------:. �.._ � _. .ate...... a EN 13 sa SAN JOAQUIN-LOCAL HEALTH DISTRICT F8s 2;677 REv.,z,/W - a'~� .3 — Cha