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. y r FOR OFFICE USE: \'�� APPLICATION FOR SANITATION PERMIT �y7 _ Permit No. _15.. .......-"............................................ (Complete in Triplicate) Date Issued ..` .:/ ..�� _._.... This Permit Expires 1 Year From Date Issued I� 6 work Application is hereby made s the a in com liante witlh Coun ytritt 0 dinarnce,Nom544 and existing Rulesinstall and Regulat onsTein described. This application is mad p I , CENSUS TRACT JOB ADDRESS LOCATION !......................•..:..... Owner's Name ' *' ��.7k'�r................. C ane .....__ IM' y Address1i... ./. + _ � !! cr = it r. ...... .... Contractor's Name .. �' telgre��"..... ........ M License # 1:. ..� .. Phone e s l . Installation will serve: Residenceo Apartment House 0 Commercial ❑Trailer Court ❑ , Motel ❑Other ............... t_ Ih i 4 >` Number of living units...--/.._ Number of bedrooms _._ ._.Garbage Grinder ./ .. Lot Size .. -f ~�'' m w , . ..,,r ...Private I�. to Water Supply: Public System and-name.:._....-•................. ........."-- 1-••--------•• - Charcrcter of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam Hardpan C] Adobe' } Fill Materia! ------ .. if yes,type ---------- (Plot plan, showing size of lot, location of system in relation too 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,) I ' PACKAGE TREATMENT SEPTIC TANK Size.. ... :................... Liquid Depth .. . No. Comportments _. ~ :............. Capacity ./ 11 -"... ..... Type d._. ...I Material. p ... Pro Line .2,�... -"• ._Foundation _..f�....._ p Distance"to nearest:`Well`"-"':- ............ .......... I�' Total Length .��.J..f-•••--..._. � LEACHING LINE } No, of Lines "-".."�......... .... Length of�.each line -,.ff��.... � g I - - ,� Depth Filter Material•----.....__. D' Box% .V-t--_ Type Filter Material _. '.. ? � -• ` /�' ! f -----_..... Pro e Line :.. Distance to nearest: Wel!": --•-••--1�M Foundation f�^ p �Y ` Depth biometer�}� _!!..°1�.. Number ___/..-.'-.-•-••._.__.... Rock Filled Yes No ,SEERAee-PIT p ..._ A_ ..mss -•--- Water'Toble Depth ... ...............Rock Size/_'r�.� - A_ ..Foundation t— ..... Prop. Line ._ - ---•----• r: Distance to nearest: Well ... _ Date f REPAIR/ADDITION Prev. Sanitation Permit# ..•----•••I•---••..... •--••.................. .w.� 1 Septic Tank (Specify Requirements) .......I.,.............""...._. F IN. f' ' Disposal Field (Specify Requirements).�..................I----------- I ---••-•---------••---. ...............__...... - ..........................ry.........................___.._-__ ............................................ ._...._...__.._....__.. ____.____.._........._...__...__........._........_...__....-.-_._.. 6 I� - -.. __.................... _.___.___.. ......................................................:...........11____.-__...___.__..._._.._....._._..._...."..._...._....__...__...__-..---.__..._....__.._....__.i w.. - (Draw existing and requiredaddition on reverse side) i1! I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin -.-; County Ordinances, State Laws, and Rules and Regulations of,'the San Joaquin Local Health District. Home owner or lice"- sed agents signature certifies the following: "l certify that in the performance of the work for which this-permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws-0f Calilfornia," Signed I Owner ' �� ' : ! ...tea`,..................... Title .. _...----••-- I (If er t an owner) FOR DEPARTMENT USE ONLY DATE . '" .... ... APPLICATION ACCEPTED BY _ . 1.r.............`......I._._....:._.....---....DATE ........................ ------------------- BUILDING PERMIT ISSUED ..... ................................ : . �I ADDITIONAL COMMENTS .. ..................."""..._._...._....._.............•__. .. ...._. ......_._......._.-- ...X .... ......._.{.__........._...._ _...._..... ......... . ..... . . :: __.... .._.4 ........ ate .. . 3........ ................... .....__..,gate ... .. ... Final Inspection by: - •. .. ... II SAN OAOUIN LOCAL,,KgALTH DISTRICT r .. 7172 3 M 1-1 24 , -4o oma.. 4AA iM