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! FOR OFFICE USE: F OFFICE USE: APPLICATION FOR SANITATION PERMIT .... Y/=t9d7/ (Complete in Triplicate) Permit No----------------------- Date Issued ......."...7 ................_----__-.__--.__.._ ............. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ This application is mode in compliance with County Ordinance No. 549 and ex isti nq,Rules and Regulations: JOB.ADDRE55/LOCAT O --------------------------CENSUS TRACT--.--..._.:..__.......... i Owner's Name.-... --�-we0�fw. ................ Phone -- ... .... Address-...-r�u„ ... ..e.:... - City. -Zip- - ^7 p . Contractor's Name.:... ... .. -'- ---- ------ - ----------- •----------- ---- -License Installation will serve:' Residence❑' Apartment House Commerce I E] Trailer Court ❑ `._ ` MAtel 3---.Other..::--- ---- 66 .01 i Number of living units:..:..._?--_-.Number of.bedrocros:..........•Garbage Grinder...,_......Lot Size.....�la�-. ...:.............. Water Supply: Public Sys'temand'name.... ................. ...............I_.............. ..... -- -; ::. ..,:..,,............---- ......------.:..Private Character of soil to a depth of 3 feet: Sand ❑ Si ❑ :Clay❑ Peat❑ Sandy Loom❑ Clay Loam ❑ Hardpan ❑ Aaobe Fil Materlal_..._.....If yes, type----------.......:.............. (Plot pion, showing size of lot, location of system in relation To'wells, buildings,:etc..must be placed on reverse side.) NEW INSTALLATION: (No septic'tank or seepagepit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) ; SEPTIC TANK - - - ' ( ] -••....................I................... .....-liquid Depth------------......--- } Capacity ......i..............Type---P ;...Materfal.r. ........._.--....'.No: Compartments.......-} ----- ----------- 1 s i... . ..:......Distance'to nearest:.Well.;._....:, w.._-.--.-,.__ ... . Foundation..: ... ..,......... --Prop. Line---------------------- . LEACHING LINE' i . ... I'1 . No. 'of Lines............................ of each line.-------.,.----:- ,--:Total length �. •.,-•-•--•---:----------- D' fox-.r..... ..Type Filter Material:..... ............Depth Filter Materl.. - ..-.........:.............:.....................-----5 i. :Distance to nearest: Well- _- ------,-_--Foundation..........:.............:....Property Line--------..--.--........... .. SEEPAGE PIT { j bepth....;---...�....Diam?ter.:......'-....- Number-.-:..R.::.................... ! t Rock Filled Yes ❑ Nc e Dept . . : YSater Tablh--�----`---- '-- '--.i.-'... -------•-`--••-----_Ronk Sizo?-----�- --••------------------------ -=-.- j” " r bistance.to nearest: Well:. :....:....c.__-..:.:--.'.Foundation..... .........`-.- -;_Pro Line..........--....------. REPAIR/ADDITION (Prew Sonitation Permit#-_- :_........ . _ ) . ..:.. .............:r.....Date.............-.""""-;-----`--.-.-:-....... . ,Septic Tank(Specify Requirements)--- i - �r r/ r - iDisposal Field (Specify Requirements) e�is -. ,.� ..:. :.�J✓� i�.-� ¢ "�L-�s " !r jt --------------------- • i r , - .I (Draw existing and requiredadditiomon reverse side) hereby certify-that I have prepared-this application land that.the w6W will be done in accordance with San Joaquin Cou Ordinances, State La'ws,`and Rules and Regulatioris of. the. San Joaquln Local Health District• Home owner or licensed agr ._. -- i. .t . r. ..�._ . - - . . . - signature certifies thee following: •.I lertify that in the petformanide 'of`the wofk for which this per'mit'ia Issued;1 shallot erriploy any person In such manner 'to becomeI cT At Workman's omh pensaon-laws-nP California." 1 { \Signed_ - `Owner By.f.... (� ....Title...;... .................. ...... ..... .......... i . - ;.�: pf er.gFian owner) F?A DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ �� - - - - ---I----- ---------- --------.-.-DATE ...- DIVISION OF LAND NUMBER. t - - .:.-- -- ---- ------------------------- -----------DATE ---- ------------ -------------- ADDITIONAL COMMENTS... .....,r............:............................. --------- - .............. - - ... ---............................... -.....:. - ' =------........ -•----....:..•.................:..................... ...... . ... . . ....................•------........:............................. .................................... ......._.. ....... ----- ---------------- -- ...:...... ...........--............ ----------- -- I / - ...-•--- ......................--------- ....... - .. ----------------- IVFinal Inspection•by:: ------------------ ....... ........._-------_ .......-...... - - ..........7-:Date-/� -_-_---^:L- - ex 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/7