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FOR OFFICE USE, _ - --------------- �-_, � ` __I..._._--- "--_- 4- 4 . APPLICATION FOR SANITATION PERMIT if] ` LDte OFFICE USE: r -------------------------------- (Complete in Triplicate) t PerNo._7� ----- This Permit Expires`1 Y Application is hereb ear From Date Issued suecI 4. This a Y +node to the San Joaquin �,, '?, pplication is made in compliance with quin Local Health District for a County Ordinance No. 549 and existin Permit to construct and install the work herein describe JOB ADDRESS/LOCATION.._ I� R �-` "` ` g Rules and Owner Regulations. 's Name_._. - - ---- --- AIM- Address ' t _, --------.CENSUS.TRACT. ! � s _ -- --- --- l' ---- Corltractor',s N - E -- ------ J tY one ._._ Installation will serve:...a ._4— - p �i House License #. M❑oteApartment - - 1 c Resi en a, _Phone_------- Number of living units:_. Commercial ❑ Trailer Court (] ❑ Other___-- _ � ' Number of.bedrooms.: -- '�' ^--�-- Water Supply, public System anc!'name 9 Character of soil to a depth of 3 feet: `t ,- Garbo e-Grinder--- -------Lot S;�-------- r, F _�// Sand ❑ Slit j] Clc- ° t -- #-- ---- 1 Hardpan ®`�t Adobe y ❑:;Peat© Sandy Loam Private [ - ❑ Fill Ma teriof_...___._.-_.If ye i,(Plot plan,•showing size of lot, location of'" ❑ Clay Loam ❑ p' Pe -j --' T ? NEW INSTALLATION:—— system in relation to(wells, bbuildings, etc..rnust be placed on r k (No septic tan0 or--seepage it i PACKAGE TREATMENT r P Per if public sewer is available within re feet side.} .� [ ] SEPTIC-TANK jij Size Capacity--` ------- _-Type-_-;_; :---------- ---- _ ._--------------- r Material - t Distance to,nearest:.Wel!------------- _ " NG LINE: °mpartments ------'---------= =----- a.. o j'l Na, of"Lines.-._.�: -"---- -_ - - --'- i Length,of each fine_. -� ._ :. ` Pop. Line D' Box - T t -------------- f- r �, : ,,Ype Filter Mater`ial'Lr- : To al Length - -"-- Depth Filter Material_._ �( - _ ---------------- SEEPAGE t • SEEP Distance to nearest: WelL"_"_- :� nd ----__._ --_f 1 AGE PIT - ---- j ] Depth --- -- Diameter" ." : . Fou ation . ' �- �-,��Prbperty�Lme�-r" � R Water N = .. .- ,Table.De - th- ' --------------- ---------------------------- a ------ , p .-.` � -.Rock � N , --------------- Dista Distance to'n'a'resf: WeIL'_ ---.Rock Size-_----- `� .F I led .Yes❑ o� REPAIR - Fou `- /ADDITION (Preva Sanitation-Permit#-::-_:,-_'--' - . :_ `" Dan a d tion___ _ t o Septic;Tank1 Pr p - ----------- = Laine .; (S ecif Req # � - to-- -- --- -- - � •. t 1 -- E p Y urrements - - ---------- :.- Disposal Field (Specify Requiremen s _ -----------------------_ --__ l' f • - w [/ ------------ - ---------------- - ----- (Draw�existln and required addition on reverse side) ------- ----------- --- --- addition -- I I hereby certify that I have prepared-this apPlrcahan and that the w Drdinances 1 # deJ w ,: State Laws, and Rules and Regulations 'of the Sari Joaquin local Health District ' work will be done in accordance with San Joaquin County signature certifies the following' r -.y::i 'I certify that in the ( Home owner or licensed agents ,performance of+the work for which this . rr . ------ f Permit is issued" become subiet to Workman's C ensation. laws California.- I shall not employ any person onigned--------------- ch man ner as --- -- Jf Y --------- ( + -' -- Owner ----------- -------------------- - --- Title(If'other twner) #� i ' FOR DE RTMENT USE ONLY i PPLICATION ACCEPTED BY IVISION OF LAND NUMBER - -- - i -- ------- - IDITIONAL COMMENTS------------- = - ` ' DATE_-LQ^ r -.,� --- --- - ---- - ----DATE--'. -- --- ----------------------------- -- -i-- .. _ " -..-- - --•------- ............. ---- r al Inspection b Y ' 3 24 ._ ,.r.,, -' - --- -'-- ---- - ---------- - ' --------- -Date��/ � ---------- SAN ---- .--SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/7d Inn `