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;: FOUR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �7 Permit1`.=--�� ............. -------- -------------------- (Complete in Triplicate) s Date Issued..f4/ ---•....... . ................ . This Permit Expires 1 Year From Date Issued � . �. rte. I r I .,� � j'.7 r Application is hereby made to.the San Joaquin Local Health District for a permit' construct d Regulations:the work herein described. This application is made in compliance with Count Ordinance o. 549 and existing Rules and Regulations: 4 CENSUS TRACT.�A.................... it JOB ADDRESS/LOCATION..."-"7c5. I _ .:. ! L--u S_....... _ ...... .-------..Phone, . s. i Owners Name .. .-.. - , Q _.City. Address-4 51* ..... s l� zip ..... .... rcic ❑= Contractor's Name..-------� " i.Q . icense �' Apartment House Comme ` railer Court ❑ �. f Installation will serve: Residence;[` e/ Motel Other'.. Number of living units:...!....-...--Number of�bedrooms...3....Gar bage Grinder.--------..-Laf Size �1 ..- private s' Water Supply: Public System and name.-_ -------------------------- .......� Sand Loam ❑ Clay Loam ❑ . Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Y Hardpan ❑ Adobe ❑ Fill Material ....If yes. type..--... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.l 'septicpclilable within 200 fest,} �"Il NEW INSTALLATION. (NO 51=PTIC 7ANKr [s ]e age pit permitted Sizei� bl sewer is av Liquid Depth..........------...•---•- I' e'� PACKAGE TREATMENT [ ] { YP��--- "� Material..fC -�-No. Compartments.... Capacity�Q0._..._T // F •t-- !�. '1F . _. Pro Line... Q- Fou�da#ion.. .. -. . p. �� h� Distance to nearest: Well.:; ..... ---� _ t� �/� ;_, Total Length ..tw_$01 � LEACHING LINE [ ) No. of Lines/ !L" Length)/of each I' - �� Type �� , C ! D' 6ox.... T e Filter Material _ 7,�._. t Material.._ .. .. c t Foundation z :-Property Line. *es No .�� .- f 7 P Y Distal;ee,to§nearest: Well.-. ....... F --•- - k� eptly--------------• ........ - .. : fi ---- r _ Prop. Lute._----- ------ ---- --- Di ------Fo�---------- --------------- 'M natation_Per.mi##_.. ) s ' . Well---------•-- REPAIR/ADDITION {Prev. So - i Septic Tank (Specify Requi ements)..... ---- , Disposal Field (Specify Requirements). ............... ""--"------ F.R .............. ._ (Draw existing and required addition onreverseside) --- -------- = I hereby certify that I have prepared this application that the workswill be�done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the .San;loaquin`.LocaI Healfh District, Home owner or licensed agent signature certifies the following: - i "1 certify that in the performance of the work f or,which this permit is issued, I shall not employ any person in such manner a to become subject to wor an's Compensation laws of California." Signed- .. - ------ .k.... ;.... Owner -• - ------ ----------- --- ..Title.. -- -----....... .............. ----- --..... (If other than owner)v .A dF DEPA TMENT USE ONLY a J DATE: . C. .. APPLICATION ACCEPTED BY-.- --._ . .. ..- . DIVl510NOF LAND NUMBER.-- -----'- .:..... ----�-� ----------------- ------- -----------.... ----".............- ... --�------- DA ��--...-- ..........- --- -- ......------... ADDITION C MM NT .. ..... .......... l = ` '-. � $ _ ...I... . --� ;�..._ �./?....�5' "XZ.e.. .. 1 . ` r �, e�.�` _ . .... Dare.... `T f ............ ------------------------ Final Inspection b AY ......."------ �---------- . - - ---- - ------- p&S 21677 R EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT