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FOR OFFICE USE ... APPLICATION FOR SANITATION PERMIT (Cempl*te in Triplicate) Permit No. ....7�.'p�!'. .. .. This Permit Expires I Year From Date Issued Date Issued .-9 Application hereby made to the San Joaquin local HeaAh District for a permit to construct and Install the work herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulatlonsn JOB ADDRESS/LOCATION 2$1.36..2.... �'1. 43Fi/D.G... .. .. TRACT ..... -y ... Owners Name --- ..BES......._ �cH.e - ._......_........... ..."Phone .................................. Address . .29'362-- ...S.. ........./' .. -BB.(D.Z...City .._.... ......... ._._. s. Contractor's Nome . _toNlNr-1 ... ................. ...........................License # ----. . _. ........... Phone _......................._. Installa•lon will serve: R-sidente partment House❑ Commercial [Trailer Court ❑ Motel❑Other.........._...............---...... ..•.-- Number of living unih:_. ...... Number of bedrooms ..Garbage Grind I .. Lot Size ......................................._. Water Supply: Public System and name ................................._...................._.........--.......:..-- .. . .Private ct $' Charaer of soil to a depth of 3 feet: Sand 0 Silt[jClay ❑ Peat❑,�/Sandy Loam day Loom ❑ � Hardpan❑ Adobe ❑ Fill Mcterlal 71/0. H yes,type............._... ......- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc must be plxed on reverse side.) NEW NSTALLATION: Mo septic tank or seepage pit permitted If public sewer is avoilo a ivIn 200 feet,) SN PACKAGE TREATMENT ( J SEPTIC TANK( Six.................._.......- _.....-. ._... Liquid Depth ...............---.._ f� capacity . . .......... Type ......_........... Martial.. . __ . .. .-. Ko. CompaAmorsb .......-......-.— 1 I Distance to nearest Well .. .................................Foundation . . ............... Prop.Urn...........-.._..-. LEACHING LINE [ J No. of Lines .- ''' ... Length of each line __ . _ .. Total Length . .............. � t •D' Box ...... . .. T Filter Material ....................Depth Filter I ................................... ' Distance to nearest: ell .... . .. ... ...._-_ Foundation _ Prop" Line .........-......... -... ,s SEEPAGE PIT ( J Depth . ._ .. ...._... lometer ................ Numbe• _... ... Rock Filled Yes ❑ No Q Water Table Depth .. . ..........................................Rock Sizi .... ......---........... _Distance to n*orest. 11 _..... .. .. _.. . ........... ....foundation `. . .......... Prop. Line ......... -_...._. REPAIR/ADDITM(Prov. So,itation Permit ... . ..._ _ _. ...... Do% ...__ ....... ..........._ .) Septic Tonk (Specify Requirements) _.-.. ......... _.. �'............... ... ....... . ..._.. . ......... _------------------- Disposal Held f5pecify Requirements) ..... pyo-. 6 x io.x...lO . .D�Lt'' uN�......APPRovF,D. (Draw existing and required addition on reverse side( 1 hereby corRfy Owl 1 have prepared this applkaROn and that the work will be done M eee*rdenee wllh San JeespeM Corny OrdleakCsy Sate laws, and Rules and Rsyelipsom of *e Sen Jeegvin I" Heeltb 01/tdct.Nem* Owner of fit*ts- sod agents 09,,so a"-ttil*s the%howl kin such manner'•I t*rN 1M of tis* for iahkh this permit is Issued, 1 shed net employ erry fewsa m to b: W me •s G aNen hsan of Gllfeirsiaw Signed r 'z'I ..._. Owner r By 7itla (If other than owner) FOR DEPARTMENT USE ONLY - DATE--� Z -- APPLICATION ACCEPTED BY IR'a BUILDING PERMIT ISSUED .. DATE - '. ADDITIONAL COMMENTS /y/ _ . ..... . fmol Insp Dare if SAN JOAOUIN LOCAL HEALTH DISTRICT F H 9 1. 69 Rev. SM