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FOR OFFICE USE: FOR OFFICE USE: -------------------- ----------- ----- ---------- --- f APPLICATION-FOR SANITATION PERMIT [Complete in=Triplicate) Permit No._.7._`�_�_�J.'�_ ` '" Date Issued 777 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permitto construct and install the work herein described. This'application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: )013 ADDRESS/LOCA ON- --. --157_i?/.--------/�.Q---q.(-� -.------ -- --1-_!_ ------'-------------'.--_ CENSUS TRACT--- 7m-v--+----. Owner's Name': ----- -'-- --------------------------------------------------Phone--•'m 4x-------- ------- Address G' e �� . . ---=- City `�� dip t _�.�C'7 /� Contractor's Name-{�`?__- . --- - 'P"------------------------ License #-- °�-7 ____Phone._ �'- --. v Installation williserve: m? Residence gg-�-Apartment House.❑ 'Commercial ❑ Trailer Court [❑ k r .. Motel ❑ Other---- ' _- Number of bedrooms Nu4mber of living units:--- � Garbage Grinder _ _.Lot Size . Water Supply: Public System and-name-- ----------- --- : . :.= : :�----- ------=-----= -----_ ------ _------------- -----------------------Private [cam Character of soil to a dept'll3,feet: Sand E) 'Silt 0 -Clay, E) Peat ❑ Sandy Loam El Clay Loam Ems— ; 4-t t.. Adobe Fill Material-_-- _.._ If est a-------------------------------- ON- Al --. _..__ -- ._ . .. .`Ha clean`❑ ❑ - Y YP I (Plot plan, showing size of lotr"I' cation of system in relation to wells, buildings,-etc.:must be,placed on reverse side.) NEW INSTALLATION: {No- septic' tank or seepage ;pit permitted if public sewer is available within 200 feet,} `j PACKAGE TREATMENT [ ]' SEPTIC TANK Lys ' ' "A Size-__'_$�'S'X 9� __::`___________________Liquid Depth.. .___ .---11Aj 0. ` _ ts 't?c'A_.,sTYpe_ L s_-Matarial__a_�o '. No.-Compartments.--Z------------------------- Capacity, ! . . „ ..Distance;to.nearest:` ell.___I►Q.__.___.r.- __ ___._=___.Eo-undation ,_ - Q =_.Prop. -Line__e LEACHING LINE. [;] Na. of Lines -: -----.y____._---,:.Length eof e��h�iina.:__Y _'--------- -------Tota( Length._- 0.,�-:------=---__- -- 5j' •D Box` y__ Type•FAer Material/ �_.______-Depth Filter Material - --- - --__ __ -- :--- i ! Q r to earestf`VIIe1 ,�Bd Foundation Property Line_. ---------------------------- :Distance FF 1 SEEPAGE PIT [ ] Depth.__i3�_:___-Diameter..____.___._._Number____ --- •'°______-________-_ = Rock Filled Yes [z}- No (�- ' WatZeer Table.Depth. I - --- ock Siz -- y ; R _ - .Distance`to nearest: Weli_ _�___ ____ }'__c Foundation----------------------- p4 -' - . ,�4 - --.Prop. Line �- ----------- G (Prev. - -- - �`: ------'--------- ------ Se ----- i Tank (Specify Requirements) - - � -----`-- -------------- REPAIR/ADDITION Sanitation Permit#___._ ____ � -_ __-_. } I Date_..___hT____. y t ' Sept c a (Sp c y --- Disiposal Field {Specify Requirements) ...... - -------------- -- --- -------- ------- ; ------------------------------------------------------ --------------- - ------------- ------ -------------------- t _�--Vie.,.._ ___ .. ...- )[F -------------------------- -------____-_------_- ------ _---- -------_----------------.______________ ___________ _s-------------------------- *; _ (Draw existing,`and required addition-on reverse side) �� L heree y certify that-I have preps ed this application that the grill be�done in accordance with San Joaquin .County Ordinances, State Laws, and Rules and Regulations of thelSan Joaquin Local Health District Home owner or licensed agents signature certifies the following: "I certify that in the peance of the work for which' this permit is issued, I shall not employ any person in such manner as to become subject"V�7kmannsation_ laws-of California.".Signed------ = a-- ------ - --- ---- -- -- - --Owner $BY-- - ---- ----- -- 1 -------- Title---- DZ --------- ---- - --------------- -------er) +: �... _ . . t 1 'FOR'DEPARTMENT USE-ONLY" APPLICATION ACCEPTED BY _ - = = DATE.. DIVISION OF LAND NUMBER------------- `{ - - -----DATE------------------------------- ------ ----- --------------. ADDITIONAL COMMENTS ------ ---- --- --------------------------=----------- - ----------------- ---- -- -------------------- -----------•---------- --------------------------------------------------------- --- ---- -------------- ,- ---- =-- -- --------- - y I - ------------ ---------- -------- -- - --- ----- -------------- ----------------- Final Inspection bY: l - EH 13 24 I SAN JOAQUIN OCAL HEALTH DIST$ICT l F�&' � REV. ��6 aM k