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FOR OF,PICE USE,, 9•t ' ��- s.�:�.- O- APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: ........%..r _ '. ...... (Complete in Triplicate) Permit No...7... ..:. 3p This Permit Expires 1 Year Fram Dot&issued_ _ Date Issued Y-272.17 1 Application is hereby made to the San Joagein Lo^ol Hd'a' 1 ''bish list fora permit to construct and install the work herein described, ' This application is made in compliance with County Ordinance No,.549 and existing Rules and Regulations: -R JOB ADDRESS/LOCATION ...7//" _.zO. <' DC7// .. µ�..-..... ,�y� ��, N� n.CNSUS TRACT. 'f Cfwner s Name - [.(,/ )/ - .. �II A _. ` �Z,:yy�,,�,��'4J,��?oG,y/(�' .... CIry...S'9xc+EYur/_ _.... 21p ... .. Contractor's Name ...... r _ et'.6r LiK11�,f `T•-H8 r�'et.cr. _License #2-V3�3 ...Pharel'K0 s55 ddress.. O, } J vt- Installation will serve: ResidencejK Apartment House❑ Commercial 0 Trailer Court 0 J t Number of ilvin uni Motel LD Other. ,y _ g its:. .._..Number of.bedrooms -Garbage Grinder .. ... cor +� Nater S•,pfi1Y Public System and ndme . ...... .. .... . .... .. . . .... . . _..Pnvote?J[f k^ Character cf soil to a depth of 3 feet Sande out 0' .Clay 0 Peat 0 Sandy Loam[]_ CIay.Loom 0 i i .� Hardnart > Adobe Fill :Material _. _....If yestype:l.. ..:. .. yPlot plan,showirb., .e of lot jocation of system in relation tow ells,buildings etc. must beplaced on revorso side.) NEW INSTALLATIGV: .(No septic tankor seepage pit aperm itted if public sewer is available within 200 feet,)' PACKAGE TREATM. ENT SEPTIC;TANK Size -. a Liquid Depth Cepa ry; _ Type ... -�A Material_..._ t:;. Flo.,Cemparttnents , 1 _ Distance to.nearest Well .... ....... Fovndatlon ....Prop. Ling _. ... ,k h. LEACHING LINE (-)--No. of Les .. ....Length of each line................... :. Total Length ._..... . _. ._ '. `- D' I.._. .Type Filter Material... . .....Depth FJtpr Material ...__.. . , 7 D,stan '1 co to nee Well Foundation \ _. ....Property Llne ..... C`„ SEEPAGE PIT [ ] Depth Diameter .......Number..... Rock Filled Yes❑ No Water Table.Depth_........ ......::. .......... ......... Rock Sae ._..... ...__.._ ....:....: %f- � Distance;to nearest. Well i..........._ ... Foundation ..... Prop. Line ._.... _..ps;f REPAIR/ADDITION (PrevSanitation Permit#.......................... Late ¢ ,s 1 " Septic Tank(Specify Requirements)......fic<- -- \� .Disposal Field (Spetiry Requirements) �pS �t..Q.r,.. "..!�-..c- �i. ..... ..._.. . . . ._ .. -. (Draw existina and required addition,on reverse side) �= I hereby certify that I have prepared this application and that the work will do mono In accordance with San Joaquin County Ordirmnces,s State Laws, and Rules and Regulations of tho San Joaquin.Local Health District. Home owner or licensed agents signttute certifies tha following: : : I certify that in the rformanca of the work for which this permit is issued, l-shall not employ any person in such manner as _ to become ub;ect orkma 's Cam ensaNen aws.of California." .1. . : . Signed ._ c .. .,.. 'owner F '.......Title..... a.-�e-d . (if other then 'w . Df:PARTMINT USE ONLY —_- - _ .. ... APPLICATION ACCEPTED BY - , .:...................... DATE . . .., ....I... .............. ....._... ��- �T DIVISION OF LAND NUMfiER.. :. .. _.__.:................................................. .........DATE....................................._.....:. ADDITIONAL COMMENTS .. - i .-...f cT r....c............$....r a lyp' t"G .{.....�.l...A...!�u.t.�..N..^.. .... I- 17 ....� . .. f....:. P . n .. ... . . ...... .... ..... .... / ................�...... ...... .... .... ... ... ..... - F:nm InspeNbn-by: .... ... : ......:. J ............ .... ."is ar SAN OAQUIN LOCAL HEALTH DISTRICT KW uv.Ins . 7 sw ✓' _ '4(i a. rc,a vw.F WiYA 36MYa!' w,JM'...V,i:fe ... ♦ , .y...aa.. _��v.n..x..Mts'Min4?py,aj4µ��' '.��.IFU,.` ,,'_