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v ..r FOR CFFICE USE: APPLICATION FOF. SANITA*!ON PERMIT ��f�� •�/ Permit No. . .............. ..... 1 m < G (ComplefelnTdplicarol n . .. ........ .... _ Date Issued .. ... ............PP... ...._. _ ._. . This Permit Expires 1 Year from Data Issued rmit to construd and described. 1'hishappl cat�d^toma�reJn compliance win Joaquin Local th County Lord ordinance for No. 549 and existing Rules alnd the Regula5onarain , r 3 3 �" . c .... . ?r� .. c TRACT .... ................ JOB ADDRESS/LOCATION ... ._.. Ph -. ' CENSUS .................. Owners name, -!bf�+.(�f tYL 4G.l�t�.. .. ...._........................ .. . ............. ..... . .. .. ... ......................_.._. i .(�.(.;.. .. . . .. ...................City 7 lf� ............. Address _. _ ..pp...... ...... ..... # � 7 Phone c1....T S .... . ................. .... ..License ._. . . .... Centroctor's Noma � �/ ... .. Installation will serve: Residence�Apartment House Commercial ❑Trailer Court ❑ Motel❑Other._.........................._........... ................ .srJ O [, Number of living units:....1.. ... Number of bedrooms .. ---•-G :rbaga Grinder'........... lot Size ..� .. . ........_. ............ ...............................Private(�� Water Svpoly: Public Systom and name .................. _.--..................... Sandy Loam❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand ��:•0 Clay ❑ Peet❑ _ Hardpan❑ Adobe ❑ Fill MatarFal -----If yes,TYPO.............. _. ' (Plot pion, showing size of lot, location of System in relation to wells, buildings, etc. must be placed on reverse side N. INSTALLATION: lNe septic tank or seepage pit permitted if public sr_wer is available within 200 feet,) NEW INST0 ' - Size.. ....... .. .. .. Liquid Depth ...................... SEPTIC TANK T ] """ W P PAC TRE�4Tf.:E'7T [ ] Materiel....... .... .. .. No. Cempariments ..........._-..-.. Capacity --- - .._----- Foundation Type . ................_ Distance to neorect: Well .................foundation .-....................Prop. Line..... No. of Lines . ...................... Length of each line...........--- ----.-----.. Tote': Length LEACHING UNE I ] Depth Filter Material .....................-..._.. 'D' Bax .... ...._. 'type Filter Material .................... P Property Lne aTi ` Distance to nearest: Well . .................. Foundation --, Rock .. Filled Vas ❑ No Diameter .. . ....... Number -- ------- - '- SEEPAGE PIT [ 1 Depth ......... ....... . Water Table Depth Rock Size.-----...._.---........... k.. . ... . .. ................... - • Distance to nearesf:'v4eli . ............ ............. Foundation . ................ Prop. Lira -.-. 1 _... REPNR/�ION(Prev.Sanitation Permit#......................................... Data ....._............. .... .........1,. ..................._ ..... -' • Septic Tank (Specify Requirements) . .. � _,-•_-- ... a... .....�.. . ...L r _........................... Disposal Field (Specify Requirements) - -�`"' --- - ..............._-- a _..... .. ... ....... ..................................I..................... M1 _. ` ...................... ..... .. ... ... - ............ - (Dry•�existing and required addition on revers!side) < bdemo accordance with San Joaquin I hereby cati iify that 1 bave prnpnmf this application and that tho work will_ It ar - .;! County Qain.=Aces, irate Laws, and Rules and Regulations of the Snn Joaquin local Henlih District.Homo owner m' liters- and sad agents signature certffi^s the following: that in she performance of the work for which this permit is sued, 1 sl+all net employ any parser in such manna+ "I certify n as to become subiect to Workman's Compensation laws of California." ,. ..... Owner .. ... .................. .. .................. Signed .... .. . ........ ... .... ._ ............ . ..... ............... ............... . Title................... .. f By...... .... ..jlf other than owner! - �,� ,t Jit FOR DEPARTMENT USE ONLY v �„�..�� — _ .. .. .. :..�. �S .... -27-- .3 .. ..... .. ... ....... . .... .... DATE DATE ` APPLICATION ACCEPTED B.. t 1°r ....... i- BUILDING P`RMIT ISSUED..........._._...............--.... . ... ........................................ _ ADDITIONAL C05:1.J.ENTS................... ....._........�........................... ..............._.............._........_..._..._......... ._._. ......... ............ . ..... .. ..... . .... .... ... ............Date ......��-... ... �d . final Inspection by ,fi-. - - " "-'• �- SAN JOAQUIN LOCAL HEALTH DISTRICT F E.H.9 1-'58 Rev.5N. 5