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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT , Permit No. .. ............. (Complete In Triplicate) ......_. --...-.... � Date Issued ... ..5�.��•.�y This Permit Expires t Year From Date issued ...................... l Application is hereby made to the San Jonqu�n Local Health District far a permit to construct and install file work herein described. This application is mad in compliance with aunty,Oral inance No. 549 and existing Rules and Regulations: 0 a. .CENSUS TRACT :....... .............:... J�J � , JOB ADDRESS/COCATIO ----....Phone ........ Owner's Name . 1 �? `...iACity . - .:...I............... ................. Address ....-- - d�f-j ....7..._ ... .. . _ p + 1� •---- -- License # .7 =J�.-..3... Phone ... ....... Q Contractor's Name �'`� Installation will serve: Residence gApartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ------- -------I....... ---------- I'— ---- i J. Number of living units:......r..... Number o bedrooms ..7�..Garbagl rinder Lot Size � ...x jJ .........Private ❑ ............................... Water Supply: Public System and name . ' 1 .. t Clay Loam Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clad Q! )Peat❑ Sandy Loam ❑ � Hardpan ❑ Adobe`* Fill Material ............. If yes,type --.- ...... ---- ----- V i I size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (Plot plan, showing NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) - SEPTIC TANK. Size... g• _.... Liquid Depth .. ................ PACKAGE TREATMENT E 7 � i 'L fj�e� ---..- Material.C�'7.t.G Not Compartments -_•..................• Capacity� _ Type l'Fy'-.- r Distance to nearest: Well •-- --- Foundation ...Gly............. Prop. line .. ..'}"--.... _. r LEACHING LINE No. of lines r. ... . ... Length of each Iline .-..l .... Total Length /.CV.................. ` n i 'D' Box ....._ Type Fitter Maternal ._--.- Material----Depth Filter Material _....1 I Distance to nearest: Well -..... � �`�° fo ndation Ip-•- - - Property Line ...... ....... rr, --------- Rock Filled Yes ( No C7 y ... Diameter ----~r-- 1umer SEEPAGEiT � Depth - �3 � - �' .y �. .� wRoclt size-Z� Water Table Depth ..............................•-------•-- ..._:. t Distance to nearest: Well ..................... ----_.......--•-Fo ndation,09 -�:_ Prop. line �...7`....._.. REPAIR/ADDITION(Prev. Sanitation Permit# _... Date .... - -------- -- k Septic Tank (Specify Requirements) ...-... ----- # ....... Disposal Field (Specify Requirements)' -------------------••• (( --------------- --------- ..... •--- -- ------------------------ -- .--.....-..... .... .._.. ....... (Drdw existing and required addition on reverse.si el= -- _a ion andNthat the work w I hereby certify that 1 have prepared this app ' iH be done in accordance with San Joaquln lic �. County Ordinances, State Lows, and Rules and Regulatioris�of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: employ a arson in such manner "I certify that in the performance of the:work for which this permit is issued,�1 shall not amp y Y p t Y t as to become subject to Workman's Compensation laws of California. Signed .:......... ....... Owner SY (If other t a owner) TMENT USE ONLY I APPLICATION ACCEPTED BY ....- .. DATE - .... /...:, ...... . . .... -- --- -. . . DATE BUILDING PERMIT ISSN D --.--. .. .--- ..... __ ' ADDITI ---- 0 M ISI :.. - ----. ....... ....--- ................ a 1�f_ I .1 -- ---- --- -- - .. -... 0 r 1 - _.--- _.__....... , _ _ . - ------ -------- --•---••---- :r. ........ Final Inspection by: ; Date ...�a.: �� / I SA�1 JOAQUIN LOCAL HEALTH DISTRICT ,i 7/723 .�i-