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LFORICE USE: ppp!(CATION FOR SANITATIION PERMITpermit No-- j `' (Complete in Triplicate) Dateissued ==` ---r--- ----- 3 ----- p This Permit Expires 1 Year From Date issued y Y !rein county Ordinance permit 'and-rex'sting Rules and Regulations•ol Application is hereb made to the San Joaquin eavlvi}heCoupytrict for a permit to construct and install the work he described. This application is made �n compliance ol ej / C ' - _CENSUS TRACT J�--- ----{ ----- JOB ADDRESS/LOCATION . �� -- Phone / ---- ------------ ------------------------------- Owner's - Name -rt 1 1 ,�,- / -q Address - ------ ---------- - J " � / -i.Li ense #/ Z Phoney . r --- _ ---- Contractor's Name _---.---- - - �.....- � I Installation will serve: Residence Apartment House❑ Commercial Trailer Court 'C] Motel ❑Other ---- ------------- - ------------ 1 u'------ ------- nits ------ -� Garbage Grinder-cJ--- Lot Size . _.__.____ Number of living units__.. Number of Broom Private ❑ - ------------------- Water supply: Public System a�d name .__ -t" �---------- CI Peat❑ Sandy=Loam ❑ Clay Loam:❑ �i Silt❑ AY ❑ Character of soil to a depth of 3 feet: Sand❑ �� , Hardpan'❑ VAdobe' iTl Material ............. If es,type (Plot pion, showing size of lot location of system in relation to wells, buildings, etc. must be placed on reverseside.j { e t it ermined if public sewer is available within 200 feet] g NEW INSTALLATION: {No septic tank or seepage.�p P Liquid Depth .............. E PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------=----------------- a p No. Compartments fft ------- Capacity ---- Type ---------------I---- Material--------------------I - . Pro - Line ------------ -- -- l Distance-to-nearest:.�Well, -k--= Foundation _---.------- p LEACHING LINE [ ] No. of Lines ------ - ------- ---- Length of each line--------------------- --- Total Length 4 'D' Box __ --_--- ype Filter Material --------------`-----Depth Filter ,-Material Property dine Distance to nearest: Well ----------------- Foundation -- , ry t --__.--_. Rock Filled Yes ❑ No I� j ..� Number - SEEPAGE PIT L 1 Depth ------------ .-Rock ---------- Diame#erg t _ i Water Table Depth Rock Size ____'-------------- - - Vie . Distance t nearest: Wel! ------------------ -------------'-----Foundation -------------------- Prop. Line .------•----`--- aI I } Dater------- ---) (REPAIR/ADDITION(Prev. Sanitation Permit# -•------,------------------------------ i Septic Tank {specify Requiremen#s) ----------.- r, ----- �. = _ ---------- me ----- l/ r Disposal Field [Specify Requirements) ------------ ----------- -------------------- I_/ .�, - b - ---- -+ -------- ---------- -II -� (A r - ----- -- + .. - {µ with San JJ - - . --- ---------------`--ce-------- -------------------------------------------------- (Draw"ex'Visting and require�d additio on reverse side) oaquin in I hereby certify that I have preparied this >pplication ulatiat►stoF the San Joaquin Local hlat the ark will be oHeal h District. Home owner or licen� County Ordinances, State Laws, and Rules and 9 ✓ i' �/ d sed agents signature certifies the following: erson in such manner that in the erformanceiof'the work for which this permit is issued, I' shell not employ any p I certify p /f as to becomesubject to Workman �Compen�tinn law�af California." ill is .� Owner -------- Signed ----� �,� s - tl - ----- ------ � ;Tie - ----- {l'flother t owwner) O EPAIRTMENT USE ONLY 3 r-- �' cy - _ ;i APPLICATION ACCEPTED BY ------- - --- -- _a------DATE ------------- -- -- ------------------------ -------------------------- BUILDING PERMIT�VSSEJED . ----- -- - - ------ ------ -=------------------------- - ADDITIONAL"COMN4 TS ?, --------------------------------------------------------------------------------------------------------------- ----------------------- ---- ----------- --- - ------ -------------------7 - - - - ------:�--^-;---- -- -- -- --- - --- - Date ----- ------- --- - - -- .. ---- Fina! Inspection b ' II `e SAN JOAQUIN LOCAL HEALTH DISTRICT , E. H. 9 1-'68 Rev. 5M. __'