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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. ......./ ~� Permit No. v (Complete In Triplicate) ..... ........ ................ . . Date issued ..,i!�-: ............................................ ...... This:Permit Expires 1 Ycr,r From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work herein described.This application is made in compliance with County Ordinance No. 5d9 and existing Rules and Regulatlonsr JOE ADC'RESS/LOCATIO ;. .1�:J /.... ✓G.�... Gr[r�..�7u CEG�'SUS TRACT ....... . .........:...... _ -✓ ... ' ...... . .. ..... ... ........ .. -Phone . . Owner's Nome �fi D �`. ,.... l.. . �'. r ,�: tr :. ... . Address � � - Ci I O L_�� . License � �C.. Phone Contractor's Name... .... �' ..... ... Installation will serve: ' / Residence partment House C1 Commercial ❑Trciler Court ❑ 3 Motel ©Other................... ....................... Number of living unirs:.. .....�._ Number of bedrooms ......2.Gorbage Grinder��._ Lot Sire .-.�..�G". ....��......••• f g Water Supply: Public System and name ............................................... .. . ...._. ..__.... ....._........... ..._..................Private : Character of soil to a depth of 3 feet: Sand❑ Silt I-] Clay [1 Peot ElSandy Loam ['] Cloy Loam Hardpan❑ Adobe Fill Moterlal,/ ...If yes,type............... ............ 's (Plot pian, showing size of lot, location of system in relation to wells, buildings, k+: must be placed an reverse slde.y2.11 �� ithln 200 foet s - r i ava:�abie w .] NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer s ... .� PACKAGE TREATML'NT [ j SEPT ICTANK� j Size........................................ Liquid Depth ..................... .. h . No.: Compartments ...................... Capacity Type .... Material...................... , Distance to nearest:. Wel ..................... .............Foundation .............. Prop. Line ...................... j LEACHING UNE { j No. of lines . Length of eachline............................ Total length ............................ ?`f i D' Box ..... ..... Type Fitter Mater'ol ......Depth Filter M-iteriol ..... .. ............................� y. t � ' ....... Foundation . . ............... .. Property Line 1 � Distance to necrest: Well ..... .........:. •-••••••-•----"""" ' .. Number Rock Filled Yes ❑ No C] SEEPAGE PIT [ ] Depth ......_... Diameter ............. .....,.................. rt Water Table Depth ..Rock Size r' Distance to nearest: Well ................ ......................foundation ...........;........ Prop. Line ...................... : REPAIR./ADDITION(Prev. Sanitation Permit# } ...................... Date .................................. ? Septic Tank (Specify Requirements) Disposal Field [Specify.Requirements] ........... .. G' a F .............................................._ . l � .. ......................... s I .. ....... .. ............. . .. __..... .........,........,........_........-.._............................... Y-X IDrow existing and required addition on reverse side] ,, 1 hereby certify that I have prepared this application and that the work will be done In accardanea wleh Sara !aageies County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home ewner of,Ilsert- " sed agents signature certifies the following: I certify that in the performance of the work for which this permit is Issued, I shall not esnPloy 0 person In such manner as to become subject to Workman's Compensation laws of California.- Sign.ed alifornia."Signed . .. .-..... . _ Owner Bv if her than owner) N OR DEPARTJ4 ENT USE O LY _ APPLICATION ACCEPTED SY ! i• ' �.l -Z--tea DATE:. �...-.. DATE BUILDING PERMIT ISSUED ... - ADDITIONAL. COMMENTS .. E ate Final Inspection by: . ©{ 13 2L 1- `i rL v. 5m .,^AnUlld LOCAL HEALTH DISTRICT 8/7ti 3M ! x