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h'r ,• FOR OFFICE USE: APPLICATION FOR SANITP.TION PERMIT Permit No. .- --/ (Complete to Triplicate) ---- Dote Issued ............ ............. ..._._. ..... .. ...__.. .. This Permit Expires t Year From Lmke Issued Application is hereby made to the Say-Joaquin Joaquin Local Health District fF! a permit to construct and install the work herein described.Th' I' lion is made n co li/q with Co' r.tySOrdin6a'1Jtce No. 549 and existing Rule3 and Regulations:: �,Sl U -� � .r UV._� ' � .H'�?/1 CENSUS TRACT � .L�..1. ... JOB ADDRESSAOCATION '� .. . . .. . . .... ,�,J — d - ' Owner's Name ....G�!e<>S.C...✓-!a:-c'�u Phone - L ........ .. . . qq. ..C ................ < .: Addraes . .X.tP�To?5� . .... .......... any . ._. q�!m�s _F c\ .......... .........._ Contrertor s Nama ...T'ex.�.�-."� _ .4�!�t l4 NI�� ... . License t1b:2 > S:w .. Phone 4..�.— Installation will serve: pesidence❑Apartment House❑ Commercial ❑Trailer Cour` ❑ rs Motel❑Other. �3 Number of living units:.......... Number of bedrooms .. -...Garbage Grindexl`114-. Lot Size ...�. ..�- �'= ----•--- Wo•er Supply: Public System and name .................................................. ....._.............................-....................Private Character of soil to a depth of 3 feet- Sand❑ Slit❑ Clay ❑ Pool❑ Sandy Loam []/Clay Loam❑ Hardpan❑ Adobe ❑ Fill Material .......... . If yes,type............................ t. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. muse be placed on reverse side.)Vl v i j NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �Y lr PACKAGE TREATMENT ( ] SEPTIC TANK[ j Size-442-Y.I.Y.94'� ... ... Liquid Depth ....../.I..--.--...... O i; Capacity!-'01._ ...... TypeNo. Compartments ..z.—........._. Distance to nearest: Well .....S ... .......................roundation /.Q................ Prop.Line.....3........__. s LEACHING LINE [ ] No. of Lines .. _.............. Length�f each line_....6-0..... ...... Total Length ...Ir�_�....._....... `s 9 'D' Box ._�..... Type Filter Materia aZ........Depth Filter Material ......��..................... ..... - S ' Distance to nearest: Well ....t�7............. Foundation ..YJ................ Property Line ......._5............. �. SEEPAGF PIT [ ) Depth Diameter Number ....................... ... Rock filled Yes ❑ No WaterTable Depth ................................................Rock Size ............................... ,S Distance to nearest: Well ........................................foundation ................... Prop. lin• ........._........_. REPAIR/ADDITION(Prov. Sanitation Permit# ................. ... ..................... Date .............................-....I < Septic Tank (Specify Requiretc.nts) ._.................. ............................ ....................................................._............._................ Disposal Field (Specify Requirements) ....................... ............ - ...."'.... .................................................... . ..... w....,......:!.y.S.l..IP.!.?.:1.................................................................................. ................................................ . ......... ........ ...........................I..................................................................I........... (Draw existing and re;v'red addition on reverse side) 1 henoy certify that I have prcvared this application and snat the work wiil be dam in accords nco with San Joaquin County Ordinances, State Law%, cnil Rules and Regulations of the San Joaquin Loral Health District. Home owner of licen- sed agents signature cerrif'es the following: "I codify'thol in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner iv as to be�sme sub act to Work n's Cyapensalson taws o California." Signred_`J.:Q 't�.�•�` /;y,^•-.ryr ..�.�.!:T. �-...........o•wncr ",�j U.. x•-s+.t ...W' ......._............._... Title �/= - .........^..................................-... By (If other than ownerl J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B'.'_T..IR-G.• ... ..... ......................._.... ._..._......................... DATE....(.Z.:..L. - _. . . .. BUILDING PERMIT ISSUED.. . _............................DATE......................... ......_... .._ ADDITIONAL COMMENTS "-' '......../ . . . ... . . ..�� ............... .... Pmol Inspection by: .�� ,t l✓`1.�.. .... ....� �7.L .. . ._ ..... .. .Dote...�L-"��_ /�.... SAN JOAQUIN LOCAL HEALTH DISTRICT s ' E.H. S 1=68 Rev.SM