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FOR OFFICE USE: Permit APPLICATION FOR SANITATION PERMIT -•j_: �3c•' ... . ..... . ....._...... No, ....:r..... .. (Complete In Triplicate) c1-/v 7i Date Issue ..... ......... "• ...... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Loccl Health District for a permit to construct and install the work hereirt described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulotlonss: JOB ADDRESS/LOCATION .... _.7o.... ^...�.....N�ti ._.,�!�.. . .. .......... . CENSUS TRACT -.: /• -+.' Owner's Name �c//7.t'` �7.1.. 1� _. . . Phone Address . .. . G.. city .......!s -.: Cmtractnr's Name ..�LU.nf/�1�...... . . .................. .................License# .... Phone .... ........... ..... .. .. lns`allotion will serve: Residence partment House❑ Commercial[DTrailer C:,-urt ❑ Motel ❑Other . ..... .... ................................. Garbo + Grinder\. S.. _ot Size . ��E$C7:F-... ...... Number of living units:__/... Number of bedrooms *,',,,.._ 9•- / Private . .... ......................... Water;'wpply: Public System an name ........ . .... ... . .............. ........ Characttr of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat C-I j Sandy Loom Cloy Loam[] tenol . ....U. f�/-�11 y e.................... .. Hardpan❑ Adobe E] Fill Mo ••If es,type laced on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be p NEW INSTALLATION: (No septic tank or seepage p"t permitted if public sewer is available within 200 feet,) Liquid Depth ...... ... SEPTIC TANK[ ] Size......................... .... ......-- PACKAGE TREATMENT O .,. N Compartments ••••- • T Material.. ......... P Capacity ... .. . ... .... ype . Pro Line...................... LEACHING Distance to nearest: Well . ............ .. ...............Foundation p• � _ . .,". . Length of each line ......... ..... . Total Length ................... , RING LINO O No. of Lines .De Depth F�Iter t'�at ria -..•. •"" - ' 'D' Box .. _ Type Filter Material .-" p Property Lina ... .. Foundation .. .. ..... " Distance to nearest: WellRocl, Filled Yes ❑ No G ( J Diame er Numbe• . .. SEEPAGE IT Depth _ ........ . .....Rock Size . .................. Water Tabic Depth ......... .... . Prop. Line ......... ....... .. Foundation . _. Distance to nearest:Well . -"•".-"-. ••.•-- ........... -' REPA;!!/ADDITION(Prey. Sanitation Permit # Date ..... ........ ) Septic To E (Specify Requirements) --. - F . .....I Disposal Field ;Specify Requirements) ..- --�� ..... ... .. .. .. ..... .... .... ... � Writs (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will bo done in aeeordae ee with �n " Ordinances, State Laws, and Rules and Regulations of the So" Joaquin Local f'ratth District. ;soma Ownerompi^` County O .non in such sod agents signature certifies the following: "t certi in the perfo c 'of the work for which this permit is issued, I shall not employ any P-'. as to bee subject to W m 's Compensation laws of California:' Owner Signed L"�.7• . _ _ '�C�-. �:__.. .. Title _..... •t By .. _ (If other than owned j FOR DEPARTMENT USE ONLY DATE APPLICATION c X� �}NTS�..;t� DATE a APPLICATION ACCEPTED BY a St1r1� .t h ,� BUILDIr:G PERMIT ISSUED ..� flC . .�(/� . ,,a ,�. �. c. . ADDITIONAL COMMENTS C 1 Lr p� S . ..Dote r r.ol Inspectio Lby •i SAN JOAOUIN LOCAL HEALTH DISTRICT E.H. 9 1.-66 Rev. SM