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.r I � e air i� FOR CrF!CE USS: :`,PPLICATiO-14 FOR SANITATION PERMIT 72 (Complete in Triplicate) ......... ... ..... ... .... . ...... This Permit Expires 1 Year from Date Issued Application is hereby made to the 2^r, Jc,oquin Local Health District for a permit to construct and inntol! the work heron described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Gegvlations: _ 1 J08 ADDRESS/LOCATION z ADDRE55/LO..CATE.O..N. l . . I .w. � CENSL7TRACT . . . 4- Owner's Name ,.�t � ,. •:-.- _.. .....f....�.,•v�'f . . . _ phone Address .eO._.<<ry....~ ;�,t. .............City .,.: .. .......... Contractor's Name..!,AT.1`: ....................................... ..License # Phcne Installation will serve: Residence ❑Apartment House fl Commercial ❑Trailer Cw-t Motel ❑Other................................ ........... Number of living units: . .1.. Number of bedrooms ........Garbage Grinder Lot Size " " S Water Supply: Public System and name .. . ............. .. F ivate Character of soil to a depth of 3 feet: Sand❑ Silt(] Clay ❑ Peat i':] Sandy Lz am ❑ Clay Loam 1� a,. i-(ardpan p Adobe ❑ Fill Material ... If yes,type (Plot plan, showing size of lot, i,rr^4ien of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: —Writ +;:nk or seepage pit permitted if public sewer is available w thin 200 frpnt,l •% \ i PACKAGE TREATME14T f 1 SFPTIC TANK q] SizeP`.......r.— �..1. ..�...-. . - -. Liquid Dcptiti u.................... fir` T r Material- � � . .. No. Compartments ......... v .. � Capcc:••f.- - yp ... ...... P t F Distc-r�c� fn r^ctrest: Well .. ........... .........•. . . .r wndation ...................... Prop. Line ..-.....-..-.-........ \ LEACHING LINE ( ] No. of I n^- ... length of each line Total Length .................. D• l~ Type Filter Material ............ ... ...Depth Filter Material .. - - . .................... Dixtcnce to neaicFt: Well ........................ Fo:indation Property Line ............... SEEPAGE PIT [ Depth Diameter ................ Numbe• .......... .. Rock Filled Yes ❑ No Q ; Wate,- IoEl, Depth ...... .................. ....Rock Size ................................ ' Distcnc(, to n,!nrest: Well ....................................Foundation ......... Prop. Line ...-............... . t ' RifMO/ADDITIONII'rev. Sanitaticn Peimir# ..... .. ................................... Date ...... .......... ........... ......) go Requirn,mr- Disposal Field iSpecify Rvquirrmrnfsl ..................................... ....... ... ........ .............. . . . ... ......I....... .................... Drow existing and required addition on reverse side) I hereby certify that I have tr-cporr•:f this application and that the work will be done in accordance wlth San Joagvh County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the f-ilowing: "i certify that in the performrmce o' them work for which this permit Is issued, I shall not employ any person In such manner asto 6eco ui )eet r 17.,,$,prnsotlon laws of California." 514nod/ [{. ':Y77 F. � _ . .. ........... Owner By 1 ... ......... Titlr i other than uv-n,•• FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Lty ;. ; :rr`f., .. DATE �I BUILDING PERMIT ISSUED . .. . ...........I...........-....I.. ........ .. ..............DATE ADDITIOMAL COMMENTS r j r.......................... - ......... i F n•t 'r.•r'rc c� tw, ! Dc,