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FOR OFM`Cf USG: APPLICATION FOlt SANITATION PERMIT permit No: _ j` ---------- W.- ---- I --------. - .._.�. .._._.._.._ tem Tri - ' a? `"%; CS;`� p u _i Date issue -7. cam, + = �t a l� j _- Phis PermitExp'sres 1 Year�From Date issued ---------------------- - - A plication~is hereb i made to the San Joa uin Local,Health District-for -aApermit. .to constr.yct and-install the work herein 1 described:This aplieation +s made in{com.p}lance w+th;Courty Ord%nante_No? 549_arid existing Rule's and'LRegulations: E � 3 DSC _ CENSUS TRACT 4 JOB ADDRESS/LOCATION .-? ---- i , - ! ' q � - Phone --------------------------- -------- Owner's s Name ---------- -U7------ --�' - ----- --------------- -- C AZ 3 Address -------- -------- - yi r , ------------- Phone ----------------------------- Contractor's ---------- ------ ,1 '----- ------ --�-==.License # - ------ � Contractor's Name ®{�(�N —4. „ a _t Installation will serve: 3 . Residenc-`e❑`Apartment House[] Commercial ❑Traile t` - Motel ❑Other,------------ =`' == h {� - Size - 7 Garbage:.Grinder ---_ --.__ Lot Number of living units:_._._-.- Numbe of bed __' � .> . .` i s .: private e� Water Supply: Public System and.name ----------- - ____ ___ - �. am' - _._: Clay-Loam-U -. . - Char_actersof soil to_.a_de.pth of 3%feet: Sand'❑ Silt[]e.- Clay_❑v� P_eat.Q Sandy.Lo ._. 't/I� Y tYp Hardpan ❑ Adobe ❑ .Fill Material _ �_ If es,, a ____---- _ 1. n {Phot plan, showing size of lot, location of systemzin�-relation to wells, b tid'+ng s, etc. :must b� placed on reverse side.) E' ifpublic sewer:"is available within 200 feet) r� NEW INSTALLATION: {No septic tank or seepag permitted y SEPTIC TANK " f Liquid Depth _ ?�___---------.----- N PACKAGE TREATMENT [ ] . ,. � „._i �t - * ~'`FYIV ` �/ 1_ Materialr_------ Capacity,, aC_- -- ;iVo. Compartments -----------/ZO_s- .:Type_ kp. Line ---- --stance to nearest: Wel! _,_ —j f-Foundation __--eO� ,Pro ------------ r , ilr__ __ ' ppline---- LEACHING e Total .Length --- --- � ----- LEACHING LINE No. of Lines Filter Mater+al ; r r ten tH of each lin _ J k �D. Bo�(,R!. _ Type r_ Material I _ bepth Fil#er - -- -j• - s f F -� 1f�- '_ Property Line Distance to nearest: Wel! :_. ___ ----- undat+on� •u: a r. .. No ` i ------- Rock Filled Yes ❑ SEEPAGE W-[ l 1Depth- _ -- -.: --- ------ Diameter �- Number ' ock Size "Water Table Depth ............. - R , ;�- ----Foundation`-- --------- ---•---- Prop.- Line -------•-•-----....-- 'Distance to-nearest., Well -.----=�=---_------------- -- ----- t _ _ ---) Sanitation Permit#--------------------------------------------- Date REPAIR/ADQITION{Prev. an+ta - ------------- --------------------------- Septic Tank (Specify Requirements) ------------------------------------------ --- ------------------------------------------------------ Q = -=_-= F " Disposal Field (Specify Requirements) ----------------------------- z -== -- -- -------------------- . ----------------- ---------------------------------------------- (Drawg q an n existing and required addition on reverse s+de) —_ red this application and that the work will be.,-done in accordance with 5 Joaquin I hereby certify that I have preps pp County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local.Health District. Home owner or icen- sed agents signature certifies the f Mowing: "I certif the p rfortnan` of the Bowing* whikthis permit is issued, 1 shall" tot` yt ploy any person in such manner e as to bet subject W�r an's Compensation., -laws-of California." w i 0 + caner . i. Sign , ,t'-'`" _`r-- ;-- -- - --- = B -----------Y �r . i-- (If other than owner) � " OR DEPARTMENT USE ONLY MATE --- - 7i1 ---•--------- twAP PLICATION` ACCEPTEDB + '� l BUILDINUEI] !! � ___.z= __,r _VT � Q� ------------ ADDITIONAL COMMENT&&- --------------------------------- -------- - --- --- --- ----- --- � Y _. _teFrrn - mow-.R - ______j ------------------. -------------- -------- .-- 1 . aDat Finallnsp STRICT JOAQUIN LOCAf HEA_+ D1 1- b8-Rev., 6M .. . FSH 9,. l _ -