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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 / Permit No./`3.T..fE. �. (Complete in Triplicate) Date Issued �.... _ This Permit Expires 1 Year From Date Issued Application hereby made to the San 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. 549,and existing Rules and Regulatidns: / -77©/. . *7 -: 1 ?4°(C? ?_Ff /. :,.:. ....ii:.�.....:.CENSUS •TR C, .:•::........... ........... J,OB ADDRESS/L4)CATaO . .i�•.!:••-• a F �� a. ..:.....;-..:.: . hone. Owner's Name .................... •--.-.......---._.........__ ..•:._._..-_....::._._....._...-........................ Pho 0 Address..............:...:.......: .... --- ......... ...........................i:-:..•...•............ City ....-•. :........................................ 1-4 Contractor's Name . .:.-..:. s#' N9' tcense 6 {io.7 3 hone ;f ::.--Rte _ . r� :'. L Installation will serve:• :` Restdenrx{�`j i4pajtmenf HovseQommercigl�T railer Coutt �] f Motel©-other :, t • 4``r' . '�/� rsa 'Number of living units:... �. ., Number of bedrooms, rbage Grinil8r Lot•S)ze' ....•� _ ................. Water Supply: Public System and name ` ' ' riv�i ate Peat .._.__.._...; .. Charade"r of soil to a depth of 3'ieet: �•5and,1]; 611t ] ,.Clay E]-' .Q. Sandy Loam ❑ Clay loam j� 'Adobe- Fill Material'. t : .•.; .Hordpah ❑ lfyes,.type . (Piot"plan, ,shoaling sizb of`tot, Aiication oPsystem in reiationoto"vvells,'buildings; A--must betilpeed, an reVetge side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l " PACKAGE TREATMENT [ ] SEPTIC TANK( I Size...:........:.......... I. Liquid-Depth ..:::._:.»........_ _ ..Nj Capacity ...... Type ................ material...................-• No. Compartments ................. Distance to fiecrest: Well .....................................Foundation ..'.................... Prop. Line ...................... �� HHHIIINNNGGG ��LIIINNN�EE _ .............. ..__. EAG ( J No. of lines ---_•---....•..----..... Length of each line.......... . TSial Length 'D' Box ....--...... Type Filter Material .....................Depth' Filter' Material ....................................-....... Distance to nearest: Wel! ........................ Foundation .---....-_-........._... Property Line ............_-_._....-. SEEPAGE PIT [ ) Depth .................... Diameter ._............. Number ......——.......-_.__.... Rock Filled Yes Q No.Q- Water Table Depth .........................................:....Rock Size ,................................ -: Distance to nearest: Weil ..................••-•------...-._ Foundation•^....._.._........ Prop. Line ........__........_. REPAIR/ADDITION(Prov. Sanitation Permit# ...................._.........4............ Date ..............-................. ) Septic Tank (Specify Requirements) .....0 ... .. . ............/...................._._.......'.... . ............l ...•...- ....._..::..:.:..:.............:. , o ............. ;� .......... Disposal Field i5pecifRequirementsl ...........�.._._...._.._.- _ � •---------0..... ...z32 :?4 ..... . ase�..... . � _........- tt .. . t.............: __ :....._............. ..................-........................ ..• (Drowexisingarkd required addition on reverse side) - I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: arson in such manner "1 certify that in the performance of the work for which this permit is issued, { shat) not employ any P as to became ble i to rkmon's Camp cation laws of California." Signed .........en . .. �U�+.nt5.. . e B .............................................. ...-._...... .._... .......-....--.. f........................ ty _ Title . r - -�w _.., —_:. . ..... r.. _..... _;...... .... ... FOR DEPARYMENT USE ONLY t }�PPUCA-T!0N-ACCEPTED,BY . ... . f.... i... DAiE . $ ISSUED ::::.:DA f ..i:•r:^'t:a:i„wry„ ' DDD TONAL:COING MMENTS.::..i:;...:.... ; -'G'J S.._. ..__:....-:..._. .....- .::........ ._ __ , .............. .....:..............------.............i...........:..-_'_-.-..-.........:::. :.:.:_::...........,..:......:......:..:..;........::.•::•::.• - i _...... .......... nal inspection by: ..)/5.:7._ ... .. ,_...,...'::..:.. ....,.-...;.. +! NiJOUN• EGt. EAL _ ; , AA .`•. ic:'u13 24 1_,a P..; 4" p� - •3]'ice;