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FOR OFFICE USE! APPLICATION FOR SANITATION PERMIT permit No. .l ��. ................................. (Complete in Triplicate) - ........ .....................•._....._. This Permit Expires 1 Year From Date Issued Date Issued �`�-4=-�- .................... County Ordinance No. 549 andiexisting Rules and Regulations: Application is hereby made to the Sal Joaquin Local Health District for- a per to eoi�struct and install the work herein described. This application is mode compliance with y wP `...-CENSUS TRACT ........... ..:........... JOB ADDRESS/LOCATION ......:......... ..... -c�: .Phony ..�� Owner e~. .� /$ ..__.... �Y�7? -.... �� i. ...._... ::.. .... .. s.Nam 0R� 2---------• ... City ` Address ��.1�: y ne . ...... ... ... �_ .. P a r1 Contractor's Name ......... _.. __.,..License #� [ Residence ❑Apartment House'❑ Commercial ❑Trailer Court Installation will serve: j i Motel ❑Other - . ?tom f?1-�`-/............... f . Garbage Grinder:_.... ._..,_Lot Size,.Z:�- ----• ........ Nuri�ber o bedroom,.s_. •<= l r� ' Number of living units:--,./ ..__._. P •vats Water Supply: Public System and name _-,----•--_.._-:_.•------- ------.-.---------- --- • S Peat,❑_ Sandy.Loam {� Clay Loam ❑ i � It Clay❑�.._ . Character of soil to a depth of 3 feet: Sand_❑ ©-•--� a __.._.. f Hardpan ❑ Adobe ❑ Fill Material ._......_... if yes.type {Plot plan, showing size 'of lot,Aviation of. sjrsteCn_fn,_relation;_tq wells, buildings, etc. must be paced on reverse side.) ; 1 tic tank or seepage pit permitted if public sewer is availabld within 200 feet,) NEW INSTALLATION: (No sep Liquid) Depth _..- -- •- SEPTIC TANK ] size..16X��':.57.�-............... .:.. j . � y PACKAGE TREATMENT ['t] tct�5r. Ma#erial.._._. C n s F artme t •-• No COMPF ....:.... P � Capacity ! 11-t� TYPe f• ` ••00 Well 7' F.�............Foundation . r-O.._ Prop. Line . Distance to nearest ............. O _ � �1 :..T-to ' Length af•leach line s:._ Z' net .._:_.. e [ ] No. of Lines .-- P �� LEACHING LINE ..._.. I r--- -�--*, N : x Depth Filter Material -#('�--•• e._Filter Material _�.�;•. I yFt ! Line .�,� ------•. ... _. { Pro a �j j :_..-r-- -• y foundation _:11t.._ --_-••......- P rtY l/ Distance'to nearest: Well -----• r NO Diarnetev -' '"Number •---•------ •----....... Rock Filled Yes ❑ SEEPAGE PIT [ ) DIpth -- F .................................. �. Rock Size Prp Water Table Depth ........:.............•-•---..........----••-•• � .. Lin __---.-----. i �_._--•---, ......................... ---•-------Foundation .................... - - '• i Distance pc�nearest: W�� F I . Date REPAIR/ADDITION(Prev. Sanitation Permit# -•••---••------- - �. : Septic Tank (Specify Requirem�ntsl `.....................• . 3 i :............ suir'ements) :... = •-•-•---- .--•---------••-•----------------- •.......__._......_.{ Disposal Field (Specify Req ------ -• ............................. I ----------- - ------- - be done in accordance with San Joaquin - -------------- (Draw, ting.and_required addition on reverse side) n i I hereby certify that l ha�e prepared this application and that the work will County Ordinances, State Laws, and Rvles and Regulations of the San Joaquin Local Health District. Home owner or luen- I sed agents signature certifies the following:— _-- permit is issued, 1 shall not employ onyxperson in such manner 1 "I certify that in the perfoimancs of the work for which this p as to become subj t Vi},ork n,s Compensation laws of California." Signed -�,-. r ...._.. ..... Owner Title _......--•--'...... -- (If other thbQ owner) FOR DEPARTMENT USE ONLY T +DATE .. _� r-- . ................... PERMIT ISSUED ...... : ....... .. ..........•.....-=---- ................+...`,....._... ...................... --- __..._...... ADDITIONAL COMMENTS....._.... ............•--•--......-- �. _.----- ' ................. . . . •.................... {........••---•--•---• ...... _......-----•------. ...................... . ..--' : _....•........._. 4...... ......- �- Date ........... y Final Inspection : ..::............. . s I SAN JOAQUIN -LOCAL HEALTH DISTRICT • 7/723 iK