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FOR OFFICE USE: !! – APPLICATION FOR SANITATION PERMIT I_. ... �G -•........ ........ ,1i (Completo In Triplicate] Perm It No ._.._-_... .........., ........... 7� 6 ••':�. :. .. .•.'��..._. . this Permit Expires 1 Year from bolo Issued date Issued .................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the-work herein described. This application is mode in compliance with County Ordinance No; 549 and existing Rules and Regulations: �I JOB ADDRESS/LOCATiON - -... 1 �_ ,D_f-l. .R.y.....................:. ......CENSUS TRACT Owner's Name ........ .......................... .•---..... ... ! Address ...r.�_os`. �Rl�%_! / ..........Pho ............... ..... ...n -Y. e '^�•- .. ..._. .--� City L/.C31��'1� Contractor's Name �1.�i- ('kms .... ... Phone �!� �r'�ZQ. Installation will serve: Residence[X Apartment House❑ Commercial❑Trailer Court ❑ II Motel❑Other Number of --••-....------ ••-•-------------•-• •-• :a living units:____�lvNumber of bedrooms � Garbo Grinder Lot Size s /moo 4 '�' Water Supply: Public System and name �1_ . :.....:..... ..._....._._ Peat .... ...... ieC:. . ....Private ❑ � Character of soil to a ctepth:,of 3 feet: Sand❑ Sift❑ Clay ❑ i ❑ Sandy Loam ❑ Clay"Loamtr Hardpan 0 Adobe fo 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 INSTALLAT#ON: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT j ] SEPTIC TANK I Size.................. ........ Liquid Depth .. Capacity .... Material-,1. Type No. Compartments ... Distance to nearest. Well I - .:..Foundation ...................... Pro Line OQ LEACHING LINT; p• ...................... ; 13 No'` of Lines ................ ..... Length of each line.,.......... Total. Length ............................ 'DBox .............. Type Filter Material ....................Depth Filter Material• Distance to nearest: Well ........................ Foundation Property Line............................. , SEEPAGE PIT Depth ••-• -- .. _ Diameter Number ..--........– _. ... Rock Filled Yes No ❑ Wafer Table Depth __----_Rock Size --------------•• ; Distance to nearest: Well �. " --Foundation p_ -----....---•---••--•-----...-•----•- � ,Prop. tine REPAIR/ADDITION Prev. " l Sanitation Permit ........... ........ __—_ Date—��—:... _ - Septic Tank (Specify Requirements). ..` .xL • -� ) j Dispos 1 Field 5 eci. - �l l P fY eq.uirements# �_ .M. ._ ------ -------- P --------------------------------------- Vo,..,.. T�. „T �. --- (Draw existing and requir addition on reverse side).-,-.-..:_. / I hereby certify that I have prepared this application and that the work will berlor+e in as Bancawith�-Stin Joaquin � County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Name owner or licen- sed agents signature certifies the following: "I certify that in the perfor ante of the work for which this permit is issued l steal! nal ern !o a. 4 p y- y person In such manner ` ` en's 47, By laws of Ca ifornia." - . as to econ, bject to Wok Signed ------- - By ................ ....•---------..-..-._-.._....._... .. ..._ -y---- _ Title ...,a� = i ,.: lif other than owner) ---... ............... -... DEPARTMENT USE ONLY > APPLICATION ACCEPTED BY! .. ----.-- BUILDING PERMIT ISSUED ''p -----..-..-:. --- - DATE ._�. �.:................ ADDITIONAL COMMENTS . -------------------- . ........DATE . •------- ----------•- ----------• ---- ---- •------•----------- •--••-------.- •--- r •._.._ .._ .._... _ ._. -------- Final Inspection by: _._... _ .- � ` ------ •--------• --------- ...--- . Date lei �3 2 1-6f3 Hev. S' i '_.. . .......... ... ! SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7 3M-