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" � ®FFIC UBS: APPLICATION FOR SANITATION PERMIT permit 7.- 7-:)--3 W ....•... ........... (Complete In Triplicate),4 Date issued.. •• This permit Expires 1 Year From©ah Issued ..........:............................................ Application-is-hereby-made to-ths_San..toaquin-Local Health District for a�permit to conatnut and install the work herein described. This application Is made In compliance vw,7.;_. on Ordinance 'No. 549 and'existin� Ruins and ltegulptlonse k .r..,.,,...4._- . TRACT .....................JOB ADDRESS/LOCA •• ......Phone ............................ Owner's Name ... , , Address ....... l��. .. ... ===.........City • ............ �o. . .� .. ..J.-��..�- 't-...Llaen:d Phone Contractor's Name . . . Installation will serve~ Residence�(Apooment•HouseQ-Commerctal-QTrallerCourt ❑ I Motel[]Other............................................. Number o$ i Lot Size • . == - Number of living units,...1__.... oomsGarbage -_ .private❑ ... • . ........,.t... . ................ p Water Supply, Public System and name ... - ..... Clay ❑ Peat❑ Sandy Loans❑ day Loam Q (J�j Silt , Character of soil to a depth of 3 feet, Sand Q Q , Fill Material , Hardpan Q Adobe ............if yes.� ............... ............ (Piot pian, showing sire of fol, location of system in relation.to wells, buildings, etc. must be placed an reverse side.) z NEW INSTALLATION& lNo septic tank or seepage pit permitted',if public sewer Is availcdsle within 200 feet,) f Liquid Depth ...�.................. PACKAGE TREATMENT ( I SEPTIC TANK Size. -- .. ! - Cam artments �� •� - 4.T a aterlal. Na. p ................... � t;apacitylr��.� Yp � � � . .' --- Pro Line .. •---•--•. + Distance to nearest, Wall ..� -� .....Foundation a p. �........... of Lines y� Length a# line. Total Length ��•.. LEACHING LINE , Na. .. - Le N4.070epth-111ter-Matedal- .. ' ` r...... ... Fitter Mdterlal' •�•7•Di Box .to nea TypeP .... ................. Distance to nearest, Well ..-... oundation �.............. Property line Number ............ .............. Rock Filled Yes No Q SEEPAGE PIT ( Depth Diameter .0, - e r° Water 'cable Depth 7.-_- -..... .. ......Rock Size 4. . ....�. ........... Well ./.l ...:�!J .......Foundation .��.--....... Prop. Line ................. Distance to nearest, We - REPAIR/ADDITION(Prov. Sanitation Permit ....... or ••• .. Date _... 1 . Septic Tank (Specify Requirements) ....... . - "_"_""" e F Disposal Field (Specify Requirementsl •L�•-`-• - - _ .... .. '. ...... ... •, G ? ....... .. ..... .... . ......... .,. ` -- ............. ......... .......................... .........................:............................. • .................................................................... (Draw existing and required addition on reverse side) - I hereby certify that 1 have prepared this application and titan`the Werk will be done In c&ccoedanei with San Jeaquln R. t County Ordinances, State laws, and Rules and Regulations of tlieyfian Joaquin LosaL,Health Dict. Home owner or licam sed agents signature certifies the following& _ - F "I certify that In the performance of the work for which this permit is issued, I $hail not employ any person ler such mannan as to become subject to Workman's Compensation laws of California." CL.ARENCE'S SEP�'IC�&-�E':'•s R��$ERViCE F Signed .......... ............ .................••---.. Owner •263 So. _ o�ittot�; Ga'•ii 9 2.05 _ Oro � ..._ -•-�7ktle E?I�..cif, .32 - . �.".tC�GL4r.;�.t � 1.6. ........ By .......... ....... I at or than owner) . it EPARTMENT USE ONLY DATE . . APPLICATION ACCEPTED BY .. U BUILDING PERMIT ISSUED ... ......................... .......... .................... ----... .._. :....................... . ..._ ADDITIONAL COMMENTS - f ......................................... •---.........-- ................................_...........I............... ....I......... l . -- . ................................... .Date .-- ................ Final Inspection by: .. ................_---------------• ` E 13 24 1-6 SAN JOAQUIN LOCAL HEALTH DISTRICT �Ta 3M k