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FOR OFFICE 4 USE, APPLICATION ICOR SANITATION PERMIT -PerAlt No. .. .......... ....... . ...... .;. .............. . (Complete In Triplicate) Date issued • j ..x.............................................. .. This Permit Expires ] Year From flab issued i her ..� Application is hereby made to the San Joaquin local Health District ordinance nan a or a No. 549 and existing RulesInstall and Rsgulat onseein ; pp described. This application is made In compliance with Y l %-. aF... ..nt ..CENSUS TRACT SOB ADDRESS/LOCATION /!.a .. .��..... .....Phone ....... . .......................... Owner's Name ......... / y :. ._....t. ....... G ?�t ice• ........Ci c"-�#t. :rf ........................ A ..... .,/ r, ..._ Ger ._ ....Erf... ............ .. tYf .:: ... Address / ..... �� t Phone �f �F Contractor's Name ....1- :�° •••'--• - Installation will serves' Residence PApartrment House Commercial❑Trailer Court ❑ J Motel Q Other .. .f r; :5. ......... "S spot Size ......... Garbage Grinder d�. ..- Number of living units:_.. _.. Number of bedrooms . � .. ...:.:.................private m z. Water Supply: Public System and name .................................. ........ ,. silt Clay 0 Peat❑ Sandy Loam ❑ My �^�fel Character of soli to o depth.of 3 feet: Sand j] C] if s,type.....:......... ............ qv 'r Hardpan® Adobe C) Fill Material ....._...... ye (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.)i� NEW iNSTALLATlON: (No septic tanks or seepage pit permitted i# public sewer Is available.withln 2t10 feet,) Size. fj ...... � .......... Liquid Depth .......................... SEPTIC TANK J I :•• PACKAGE TREATMENT 4 " r � Compartments r•.�•�-.......•......... Capacity .... Type . !r� ' 'rMatsrial_..c': �ff: r.!...." Nod Co `........... Well' : . .Foundation . : .... Prod.Lln - i Distance to nearest: .... - --... I Length ._ �.�` ................. q Tota ..._ Length of each Ilne. ..1 LEACHING LINT: [jc� No. of Lines ...::_. ... , ............ ........... Filter Material ./�, !?!.Depthi{ter Material j - •; `D' Box f'.. Type .� Property Line ,..... ... ......_. Foundation. 40 Distance to nearest: Well .:. f f� Rock Filled Yes, No ❑ r . ........ Number ........ SEEPAGE PIT ( Depth ..,a= Diameter Rock Size . . •'- - . I. .r.., ....r Wafee Table Depth •---•---• . .................................. ,�f �.... Prop. L . 10111;*•2_1 I ........ .Foundation • Line Distance to nearest, Well :. .. ittion Permit .................... Date .................................. REPAIR/ADDITION(Prev. Sana ...,.• . ..................................................... �?........:._........r................. Septic Tank (Specify Requirements! ......................................... .............0. " ................. Disposal Disposal Field (specify Requirements) ........... . ...............I............ ................I..�..•- -•.. ... ....................... _..._...... _....._..................... ........................................................ ...__......__... ... ...... ..............I..... ................e....---........__......,.._.._..... .._ ............ ........................... (Draw existing and required addi._tion,on reverseside) t 1 have prepared this application and that the work will be done In accordance with San Joaquin 1 hereby certify tho P County Ordinances, State Laws, and Rules and Regulations of the San ,loaqutn Local Health Qistrict. erne owner or lican• IF A sed agents signature certifies the following: permit is id, I shall not etnp 6Y any person in such manner ".I certify that In the performance of the work for this p issued, 1 as to become subject to Workman's Compensation laws laws of California:" . Signed ..... -"7�.....� .��....... , ....... -•-•- ............. Owner g /.c ..... "' ---•----•----• Title ......................... By ..................... ......... (if other than owner) fOR ncDARTMENT USE ONLY APPLICATION ACCEPTED BY .. ._ . . . ....................................,......_............... DATE ............................................ .....DATE .. BUILDING PERMIT ISSUED .. ADDITIONAL COMMENTS ......... ..................................:..............._............_....._... ............... ..-•--•--•-•-- ..........---................................................... ........:........ ........'..............._.._... _....:__:••.................. . ...........•-..._....__.................... ......_ ..............-,_................._... Date... "�`�- w� .......... .. ... ----....... Final Inspection by: ... .........I..............• �?�1 IIs 13 24 144 !N SAN JOAQUIN LOCAL HEALTH DISTRICT