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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No; ..'�-•.33V �i .......... .> -------------7................... (Complete in Triplicate) _ 1 t� {{{ P /t/ 7/ _.....` ................ ... -- Date Issued -._.. ...... �. This_Permit Expires 1 Year From Date issued Application isAirebytmode to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: .....CENSUS TRACT -*�/•.--•• JOB ADDRESS/LOCATION ..... . .. • --lY-W / - ^D E Owner's Name A'f�/-+� - -�'x S .::................... ._ Phone . y M1ANTE.c14 .....x.--------_ Address ------- - -wy-------'7-�.�Q--=---.i-..:.. City ...----. - - ............. 1/10- ..._..c..-_...,�1----- Contractor's Name .�.Lll f�Cl. f ------------------------ License # _... ---_-------- Phone ....... ...................... h Installation will serve: I Residence \rartment}�ouse❑ CommercialTrpilet Court . ( to 7oA4 'Motel EI-Other ._. ---_---------------- ..... . _ _ +r t fn ._t J-r d � F S Lot Size ..! CR C--- Number of living units:_..-..1... Number of�Te rooms,. Garbage Grinder \. ,/ - - --� ....._ ............ -.....:Private-C7 V Water Supply: Public System and name .................f.( ------ . - 1 1 Character of soil to a dJpth of 3 feet: Sand U/Silt 0 Clay ❑ 'Peat /r, 5(andy Loam Clay Loam 0 Hardpbn ❑ Adobe❑ Fill Material .[K.O:-- If yes,type ----- ...................... 7 (Plot plan, showing site of lot,f location of system in relation to wells, buildings, etc. must be placed on reverse side. ` NEW INSTALLATION: (No septic tank or seepage Pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Y ] Size-------------------------- #............•..... Liquid Depth ........................ Capacity . - - Material....----' ---------- N Compartments --'c................. P I - - Type Distance to nearest: Well - ------------------------•---------Foundation ......... _...- Prop. Line ..........,..:...... 7 Length of each line...:....t'----------�- .... Total ,Length ;......................... LEACHING LINE [ ] No. of Lines ..............._-_._-- i �. 'D' Box'............ Type Filter ateriol ... ..Depth Filter Ma rial ..y................................... :.. Distance to nearest: Well _.---.. Faun ._..dl---------- - Property Line. .._._..----•.---- •••_ SEEPAGE PIT [ ] Depth 'C Diame er ------_--.._.. Number ......::................ .. Rack Filled yes 0 No I[ j Water Table Depth Rock Size ........... ..........✓.._... Distance to nearest: Well . . _ Foundation ..... .........YProp: Line ..-........--.--.. I "a REPAM/ADDITION(Prev. Sanitation Permit;# _..----. ; _ . .._. .. V .... ................_:� . -- .Septic Tank (Specify Requirements) ------------------------------ ------•4•••------v..-- ---------• - -a l Disposal Field (Specify Require}ym-eentsl .-----ADL--------ACA. .... j-t0`�`"- -"V��N......4I-��- --•- f ......... .. . - --- . --- (Draw existing and required addition on reverse side)' I _j " cation and that the work will be done in accordance with San Joaqu I hereby certify that 'I hovejprepareil_ this application County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lice i sed agents signature certifieihhe following: I "I cerN in the perfo c of the work for which this permit is.issued, I :hall net employ any person in such moor ` as To bec sub t�, 's Compensation laws of California." . l Signed/� - .. .. --.. .. .. Owner - ------. Title ..........:......_............. .--....... (If other than owner► nFOR .DEPARTMENT USE ONLY ' APPLICATION ACCEPTED i .B..- LFT . _.--- _ . -�..:.DATE BUILDING- PERMIT—ISSUED= ...... .. t ADDITIONAL COMMENTS _ -:,. .:... ..:: ......: Final 11 spent' - .`. - ll �1 SAN JOAQUIN LOCAL HEALTH'°0ISTRICi:.