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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: n " - - 1Jf (Complete in Triplicate) Permit No,$.`_-76J._ --------------------- Date Issued./Q_-�_.-�$� 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 described. This application is made in compliance with County Ordinance No. 544 and existing'Rules and Regulations: 'tr- JOB ADDRESS/LOCATION .._. 00D- ___-_ jj"- _I -------CENSUS TRA -- Owner's Name-------- -_-- _ ----- ------ Address--------------- -------- -------------- ----------------- ------ --- .Phone.- . -�_. or's Name. - "- '? - -Zip - Contract _--- ----- L , 3 Phone 7� ' installation will serve; Residences Apartment House.0 Commercial� Trailer Court ❑ { ,. ; .-.,i. .�. ....�. . . Motel _.-=----� ---- -. Other- Number of living units:- --------_-Number.bf..bedrooms ._- __-__Garbega Grinder_ -_ - Lot Size Water Supply: Public System:and name----- --- - Character of soil to a depth of 3 feet: Sand 'Silt CIO ' Pnvat c e a ❑ ❑ y ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ # Hardpan ❑ Adobe Fill Material___-.____.._lf yes, type---________________"___-__.__ (Piot plan, showing size of lot, location of system in relation to wells, buildings"'etc.,must be placed on reverse side.) NEW INSTALLATION:'" (No septic tank'or 's'eepage .pit permitted if public sewer is available within 200 feet} O PACKAGE TREATMENT r r i ] SEPTIC TANK [� .. . _ . p, ,. O, ze X. v-- ;..._.. Liquid h ��r�� -- -- - iqu'd Depfi Capacity f+r"`r TYPe----- -- � " '. Material__` -'_No: Compaitments '---------Z------ -----=' r r � Distarice_tA-nearest:-W�l•I.--=---/ ----f ---------=Foundation.- ---- --,ti.----,--.Prop. Line__ -___-----_------------- ----- LEACHING LINE; No. of Lines__. �----------------Len th of each.line _ <, To _ _ D' Box.__ ..11/_Type Filter Material-! � t ! epth Filter Ma�erial-----L - Distance to narest: Weil / -t--'- ---------- -------- .........- • ------ 47 ----Foundation--- �-- Property Line SEEPAGE PIT Depth---��__--Diameter._- � Number--- ____--- � __--__ y r Yes�] No ❑ # # .. .. Rock Filled ater Table Depth---� ---- ------------'------ -.- c e ,T/ R ri # ------------------- Rock Siz .__- "yX --------------------- Distance to nearest: Weli (� o`" . -� Foundation =$---------------Prop. Line----�;r- _____ _ 1___w REPAIR/ADDITION (Preva�Sa nitation-Permit#�- �___--___�.-� Dat mlents]-_: ------------ : _ -Septic Tank (Specify Require `: -- Dr --- ) - t -- Posal FIdj' PecifY Re#q ur'ements}_ ________ _ _ _ l. ------------:-- ------------------------------------------ --- .-�- - --- ------------------------ ---------- -- ------- -- 3 p ' " (Draw existing ancf(required addition on-re rse side) - ------- ------------ - . ------ I hereby certify that I have p� aamd-this"application-andithat the .work will be done in accordance with San Joaquin County Ordinances,, State Laws,:aj4, 41 Rules and Regulations of the Sari Joaquin.Local Health District. Holints signature certifies;the fdllowing: me owner or licensed agents t t Z -,>L_f Cl4.tl' 4 "II that in the performance of:the work for which this permit is issued' I shall not employ an ' to become subjectto% Workman's. Compensation laws .of California." P Y Y person in such ma i I 1 Signed__ ----- - - a --------------Owner b: BY - -- 1 t re --- --- the� than o'" - T I ----- -- - 1 caner) :. _ �-----. -:- -- -_-:- O D ART) T USE - APPLICATION-ACCEPTED'BY-------- = -- .. ------------------ ---------- DATE.--- -f-------- --�-�-- ------------------ - --- --- -.- DIVISION OF LAND NUM61=R.---- - ----i ------ - -�- -- -- - -- - - --------- ---- --------------------------------- ADDITIONAL - + -- � ----- - ---------------- -DATE---- ------ -- - ADDITIONAL COMMENTS _ _ _ . ------ ------- ----------- = � $ --- -..-------.-------_--- --- --- ---- - ------ --- --- -----_- ---- ------------------- :_ -- - ----------------- - ---------- - _(�---------------- Final Inspection b _ ------------- --------------------------------------- ---- - ---- ---------- ----- --- T - "_,Date ------ eH 33 2a SAN JOAQUIN LOCAL H241-TH DISTRICT rs.s 21677 REV- 7176 3m