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FOR OFFICE USE: ----------I PtA - APPLICATION FOR SANITATION PERMIT V- -- ------ (Complete in Triplicate) Permit No. 7 __6 S�-�_ l - -------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and+icy described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulationsrein JOB ADDRESS/LOCATION ----1-0-10--Sd-:--...!_a�--------------------------------------- ------------_._____________CENSUS TRACT wner's Name x ii[ B• Bruce----------------------------------------------- X64-82 0 ----------------Phone - 7 Address _SRM@ _-__-___-- _ Cit - ------•- - S tkn Contractor's Name -------Blackard's - --- ------ ----p--------------------- ---- - ❑ ------.License # --- - Phone 63 70i1 ---------- Installation will serve: Residence Apartment House Commercial []Trailer Court i❑ Motel ❑Other Number of living units;_---------- Number of bedrooms ....Z_____Garbage Grinder ____._____ Lot Size ____12__�cres - - ------------------------- Water Supply: Public System and name ________________ ___. _ - - ---------•---------------------- - -------Private �] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe M Fill Material ------------ If yes,type ____________________________ (Plot plan, showing 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 [ I SEPTIC TANK'{ O 7 Size------------------------------------------------ Liquid Depth __ ------------------------ Capacity--------------- --- Type -------------------- Material---------------------- No. Compartments ...................... 0 Distance to nearest: Well ------------------------------------Foundation _________________--- Prop. Line __.___.___..._.. LEACHING LINE ------ No. of Lines __l________________ Length of each line----------6m-----.------ Total Length _60.1 Box __1____ Type Filter Material .... ________Depth Filter Material ____�9n Distance to nearest: Well ____ 0�___ Foundation _____40_!------------- Property Line ------1QQ....... UL;LAMP.Ag3F_P.LT [gJ Depth -----$!---------- Diameter _. !_X_lQ'Number ____] -------- ------------ Rock Filled Yes [ No Water Table Depth _______-90-t---------------------------------Rock Size _____ _ 1 Distance to nearest: Well ---l_,X0.0---------------------------Foundation ______6Q_1-______ Prop. Line ...10Q_i•__..___ REPAIR/A UU,( UIPrev. Sanitation Permit# -------_------------------------------------ Date Septic Tank (Specify Requirements) ---------------- Disposal Field (Specify Requirements) -------6a!---Lear-h_S,ine---&--Sump---4!