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FOR OFFICE USE: / °"` <br /> PLICATION FOR SANITATION PER <br /> (Cempleh in Triplicate) S- Permit No. 7 - 'Y <br /> This Permit Expires 1 Year From Date Issued Date Issued ./D�- y <br /> Application is hereby made to the San J�oquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION v..v_. _ 5.. . .. f,�fJ,. .a� ,. .. SUS. TRACT ... ....... ........ <br /> Owner's Name /?. `. .Txr- .... ./_....A.►-�.y--/.i............. .......................... Phone . <br /> Address $if -- .- <br /> -d._. W-04. ./.�t'.�°`w..................... ............ City .Sr��''��....................................................... <br /> Contractor's Name .. :.. ._ i ..........Licensee -- Phone ... . <br /> Installation will serve: Resideriice ❑Apartment House 0 Commercial'❑Trailer Court 0 <br /> Mgtel ❑Other __ - r� _ a..:6.... <br /> Number of living units. Numberiof bedrooms Garbage Grinder Lot Size kf..&C> • <br /> Water Supply: Public System and name 4': .....Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loom ❑ <br /> ` Hardpan ❑ Adobe ❑ Fill Material ............ Ifs, <br /> ye type ........ .. .......... ._. . <br /> (Plot plan, showing size of lot; location of system In relation to.wells,.buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank 4r seepage pit permitted if public sewer is avoilable within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TA4 i ] Size.........................o{ ....... Liquid Depth ....... <br /> l . <br /> C7.Copocity . ¢�-. <br /> Type . ......... .- Material.... No. -Compartments ;..........� <br /> 4,rj f Distance to nearest: Well _. ..................Foundation ..-. . ._........ Prop. Line <br /> LEACHING LINE [ ) No. of Lines Length of each/line .. Total Length <br /> / r �� <br /> F <br /> , t ? ? D' Box00 Filter MaterI0W13.r j.-j:5'.{. epth Filter Material - <br /> Distance to nearest: Well ... ...... .......:.•-- Foundation ... .....z..... .. Property Line ........................��( <br /> SEEPAGE PIT [ ) <br /> Depth ::. ..... Rock Filled Yes ❑ No O <br /> I1 <br /> Water Table Depth <br /> ..._._._�.,, P Diameter................. � _ <br /> {V <br /> ' <br /> Di nce`to neorestt Well ................. W.1W ion -- Prop. <br /> ItEPAIVADDITION(P''rev. S rhtotit' Permit ........ ...... ... ...... I <br /> Line <br /> . <br /> t <br /> ► I ............ ) <br /> Septic Tank (Specify Requirements) _. <br /> .. ....... .................... ......... .............................. <br /> Disposal Field (Specify Requirements) .............. <br /> .. ................ <br /> ........ <br /> (Draw ---- ---- ---- ... ....I.... ..... <br /> xist ng and required od4i-1 n everse side) <br /> I hereby certify that 1 have prepared this application and that the work be dent In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Spn JOG' W N4211th District. Hem* ownouor <br /> Ncew <br /> sed agents signature certifies the following: } <br /> "I certify that in the performance of the work for which this permit is Is�u lis i net 1 <br /> as to becomes . jec to Z�� <br /> laws of California." P°y ally person in such manner <br /> Signed .:. Own�/i <br /> er <br /> By . . . . :......_. title <br /> (If other than owner) ............... <br /> --_ - — ENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE . . <br /> BUILDING. PERMIT ISSUED .:.:.. .. ._ . . _.. <br /> �� � S'r( <br /> f:3.. . <br /> ADDITIONAL COMMENTS . ....DATE . ................... <br /> ........... <br /> .. ........ ............ <br /> _. ...... ... . <br /> -•--•.. .................__._......_....... . : <br /> .................. ... ..... <br /> Final Inspectionby- <br /> ---- -------- .._....._ . <br /> j.. ...Date .. <br /> M.. N µ UtN HIg <br /> E. H.13 241-'68 Rev. 5M 7/72 3 M <br />