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.�.. FOR OFFICE USE FOR OFFICE7USE: APPLICATION FOR SANITATION PERMIT permit No7.- - -- -- (Complete in Triplicate) �_, - w Date Issued -- ---- -- -1 ed ---------- - rThis Permit Expires 1 Year From DateIssu�.. _ ?-� �A permit to construct and install the work herein descri e Joaquin Local Health District for a p Rules and2Res�otions: Application is hereby made`+o the San ,loaq ) cr 4 �liance with County ordinance o. 5 �3e„ting 'j %/ , - CENSUS TRACT. f - - o ~ This application is ma e in rn��J n Y`^ LOC `� - - �-- ^`P-Flo e - JOB ADDRESSf 0 67 . ----- I - J. t"7-oq_ Zip Owner's Name--- d7_ _l - t 1 city... 9�QP-•� f-tet'- 1 .dl C f(�?.p - �"s._ .. !2� � . . . � !Phone-� _-License Address I t( Trailerrt l `' Commercial ❑ Contractor's Name.=:- (�es�dence --Apartment House.❑ r . . Installation Will serve; Other------------------------------ Lot Size .-�---- - -- - ----- `�-'_ i `.Garbage Grinder_ - --- -- --Private units:- '------ urriber of bedrooms- r / --- Number living zy t� • ----------- of boa - �.. V Public System and name__. .._-----Y Si-It t Clay Water Supp Y= S : Peat❑ Sandy Loam❑ m " of 3 f'et: Sand ❑r1f yes,type--------- ❑ Clay � _ W Character of soil to a depthFill MatenaL ._ Hardpan'[] Adobe : ,� • - buildings,'etc.must be�placed'onJ�revexse-si e. —•- �-` e (Plot plan, showing size of lot, loccltion of system in lep t' perm`s edsifpublic sewer is available withtin;200 feet,] h _ No se t� #dnkvor- seepage p P i r f Liqu"d Dept .� / •_ NEW LLATION* is PACKAGEATREATM NT [ ] r 4 _Id Mater No. Compact ents_r-- -------------- ---- -- SEP";1C�TANK � Siz --- �- _ e._ a -.- ` Capacity 4C _'_ YP Foundation--- - --- Propti Lsn� 1 --- r ten -- Distance nedrest:,Well {_© _ - :. . . -..—Total gth p�` l cr G LEACHING LINE No..of LVs.___ _ „------ e gt'7oe --------- t ---- i`D' Box___' ._.__Type Filter Material_- Depth Filter Material_--- - ------ -- 1 - - ----- ------- ndation-- - -�-�Q-- --- -.Property Line ---- --r No'❑Distance4 nearest: Well . - j ed Y a f/ Number. �--------------------- k F�11 4 Roc es ,�, : " ��'-- ------------ -- SEEPAGE PIT Depth .-=.----fliameter_ c 4___ Rock Size------------- =- Water Taae Depth .__l' ; Prop. Line---- 6 l — -:--- -•------- L F -Foundation"- P p _ � Dtance:ti,,nearest:Well._ -�- �- -- -------------- is v . Date REPAIR/ADD1T10N (Prey. SanitatioPermit#+s------- tk--4, -_--.-.._.---- ---- Septic Tank (Specify Requirements) - ------------------ -- ------ ------------------- ----`------------------------------------------, e - Disposal Field (Specify Requti,remensi:_- - ------- G ------------ - - :_ - - i --- ------------------------- ----------------------------------- i .. - ------------------ ------------ ----- -- _ - -----------------------:------'------ - - (Draw existing and required addition on reverse side) . Iy ))cation and that the work will be done in accordance with San Joaquin Count ,'a,`2teby'certify that•l have prepared this app iAAocal Health Mations of the San Joaq) District. Home owner or licensed agen' Ordinances, State Laws, and 4 Rules and Reg -,. ` signature certifies the following r - per in-such manner 141 certify that in ih erforr_n F�of the work'o+,i which this California."peimif 5 'ssued, I shall not employ any p to become sub ect o kman s C p ---- �+1�� '-" - ------------ .. z -- Signed-_ y ---Title. ' --------------------- .(If ------------------- BY FOR (lf other than owner] � 3- `x DEPARTMENT 175E ONLY _ ----- DATE ------- DATE. APPLICATION ACCEPTED BY --- -- -- ----; 6--1----- ---:-------- --. - _ ________ __ _ ______ _________ _-------_--------------- -- - - DIVISION OF LAND NUMBER..`--- , -7 ADDITIONAL COMMENTS -i - -------_.- - r ` j s�----------------- -- ------- --- a t --- " - -- �� _ Dote-- 4� _ .. .............. .... " "" F&S 21677 REV. 'Final Inspection by:-._L,g;--: - -, = _ ✓1 SAN joAQUIN..LOCAL HEALTH DISTRICT EK 13 24 �.,