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POR OFFICE USE: APPLICATION FOR SANITATION PERMIT L.... ._. f*lPermit No. 7� �d� lComplets In Triplicate] - �. This Permit Expires f Year From Date Issued Date Issued ...........•........ . Application is hereby Tade to the San Joaquin Local Health District;for a permit to construct and install the work herein F described, This opplicaition is made in compliance with County Ordinance No: 549 and exit Pig R es and Regulations: JOB._ADDRESS/LOCATION. ...:f..._I ....d-.:...,� ,f l;S�/.��G� Owner's Name 1��r R014 -3r- Phone ...lo.®.C2..... Address _ ._....--•................... .......... ity ....... --' ............. Contractor'-s'Name _._. /11 .. --- ............................. ........... ...... Icense Phon e ; ' Instaltation.wilt.serve. Residence['Apartment House Commerc railer Court 0 Motel ❑Other.................................. Number ofd livin uniits•..._. Number of bedrooms .._...Garbage Grinder ............ Lot Size i Water Supply: Public System and name ........................................ ... .... . ..Private ❑ ... Character:o$-salt to a de th of 3 feet: `Sand' Silt "Cla p ❑' ❑ y ❑ ,,;at ❑ j Sandy Loam{ clay loam 0 Hardpan p . Adobe❑ Fill Materlol .. If yes,type/ ... F I t , (Plot pian, howing size of lot, location of system In relation to 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,] PACKAGE TREATMENT [ • SEPTIC TANK size...... �v -0 �_ Liquid Depth .. Capacity , dnest:_`W611 Ype / -Claterial.'�--- •�- •' No.No./ .•�"r d� -Distance to neo ..................... ;:� � ..r7�. . N -_; .. .. ... Pr ...................... ounda#Ion _ o . p Line LEACHING EINE M No. of tir=es `� -` .. Y ` Length of,eia� lin T 7 taI Length .,� ....... Q De th, Filter aterial • 'D' Bax ... ._.:.. Type Filter Material /..� M ...:.... ' ._ .............. E Distance to nearest: Well . /Foundation y:_.... ' ..........rP roperty Line _SEEPAGE PIT Depth .................... Diameter --- A--..... � ._.. ....Rock :Filled �Yes No Water �Gt Table Depth .:.: ........ ................Rock Siie ...........: !: ' . . Distance to nearest: Well •--•-•....._..--�' - , .... ' ..........:-•;Foundation - ..........._.. ..... Prop. Line . REPAIR/ADpITION(Prev. Sanitation Permit* ......._..._. .......... - to \l,•r -----•--•-------.. Date ..................................} Septic Tank (Specify Re uirements! ....•-------- ................ .......................-----{-• --.........•- Disposal Field (Specify Requirements) -� 5 jE1 � I II - ... - ... -n. ..r.a r• r..-, .-r fir. •� � .4r'_��.'-�_' >. ....w%'Q ..... ................................. ...... . ....... _-___... _----•-----Ip........................ •...................................... -- - - --...._..-----.. ..----._..._----•-• {Draw existing and required a-.ddition.............on....'reverse--=-........side..._...]...... ............:...._....__•--•._...... ................ l I :hereby certify that I have prepared this application and that the work will be done In accordance with Son Jeoqula County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healih;Dlstrict. Home owner or licen- sed agents signature certifies the following: "I certify that i the performance of the work for which this permit is issued, I shall not employ any person In such manner as to beco lect to r a ' m n laws of Californ ' Signed ' :L. . ._ _.:... - -- Ownef, BY ........... If. ...... .........•--_............................. ..--- _.... fit •- --_ ----.._..._.._.-....... ,�{I other than owner} i F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___ - .................... DATE_.,,. .-.- ._.�......... BUILDINGPERMIT '1SSUED ...................-...............................•--•-----•••-.. .................................... ...DATE ........... ........._......._....... ADDITIONAL' COMMENTS ------------------ I ----------------....!I..........___.._._-__..._.._- ............___._. ....................II................_...___.__.-...-._...._ _..--•. ••..••••-___._ • , ---......_.•---------- ••---- -.---•--• Final Inspection by: .................. ....... .. Date ....._..._.. ... _._ i .................... ............. __---..__...__._._.. .. .- . . . ......_............ EH 13 1'6 lav• 5M SAN JOAQ IN LOC HEALTH DISTRICT ' 8/711 3M Q