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FOR OFFICE USE: APPLICATION FOR SANITATION �RMET Permit No. ! (complete inTriplicatell �.. Date Issued ----.- .-. ...... This Permit Expires 1 Year From Date Issued .........-' ............................'-._.. Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein licmac is mado, in compliance with County Ordinance�lo- 549 and existing.Rules and Regulations: described. This app ' � fr1., �_ 77ENSUS 'TRACT -------------•--.----- Pho JOB ADDRESS/LOCATION . .. ------ - Owner's m .... Address .. A.. -- cagy Phone ----' , 1 icense # I-��-1 , ? '�. - Contractor's Name ----SGx�T'r-r:.-- - ' R�sidence Apartment House❑ Commercial;❑Trailer Court ❑ Installation will serve:' Motel ❑Other..... � ~ t \ -- '............x-'---•--•- __Garbage Grinder ...-- Lot Size ---- --- y Number of living units:_.r... Number of bedrooms .._-:- _.___Private Ip IPublic System and name ----- ------`---- --- - -'................. ------------------------- ---------- " ..Loam []t Water Supply: Silt❑ Clay ❑ Peat❑ Sandy Loam ,[] Clay: Character of soil to a depth of 3 feet: Sand❑ Fill Material ....-------. If yes, type--------------'\......... Hardpan [� Adobe [] r showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (Plot plan, y NEW INSTALLATION: ` (No septic tank or seepage pit permitted if �bli� sewer is available within 200 feet) d uJ F � ------- ---- Liquid Depth �`:........ ......... SEPTIC TANK{ Size✓�� -x- PACKAGE TREATMENT [ ] Materials No. Compartments - I S Capacity .j. m-G?....,.-- TYPe .._- f `., e �� Pro Line --'-';-"j•--> ( ;1,y� t Distance to nearest: Well ..........�t?g------------- -•-Foundation ____.. _- P• t 1 -_- Total Length ;..........= No. of Lines _-_A-- - ------ Length of each line....�.ftQ.'-----..-- 11 LEACH_ I_ I, [ i l )'D' Box'.-. --. ---- Type Filter Material :_ -.1 ........Depth Filter Mat.... ._Proper --- --- -- Distanceliri nearest: Well -2-104P.- .---- Foundation ....IA----------- ---- ----.--- - - Property Line. --3---•---=---- �_... Number __-._-. Rock Filled Yes 93 NO ❑ Diameter _�3--� m?. . .......R -. SEEPAGE PIT [� `Depth ;.-�s......... �Water Table Depth Rock Size n------------------------------ Water ------------- - -' �T 1 'DistanceI,to nearest: Well .-'--------------------- Foundation ---'- Prop, Line i I J ..... � REPAIR/ADDITION(Prev]i Sanitation Permit# ...-....._--- -------------- -- - ----- Date ---------------------------------- ------------------ - -- - .a.•.-----'--"-'-' . . ------------ r Septic Tank (Specify Requirements) ------------------------------ - eci Requirements) - - ........................... I. --- -------- ---- ------'--'---'-- Disposal Field (Sp fY. -- - ------------- ..._ . I (Draw existing and required addition on�revefse side) d I her certify that I have prepared this application and that the work will'be one in accordance with Son Joaqu ealth District. Home owner or ficei County Ordinances, Srare Laws, and Rules and Regulations of the San.Joaquin Local-H sed agents signature certifies-th8 following: p person in such mann "I certify chat in the performance of"the work for which this permit,is issued, I s all not em lo`y any p -.,. . Compensation laws of California."' as to become subject Owner ect to Workman's -------------- Signed --- ----- -... -- �_--- - Title -_.:. ¢L0<?-_� . ................- - ._ BY (if other th&n owner) , ( FOR,.DEPARTMENT USE ONLY f 1 t DATE .-.:.:..� APPLICATION ACCEPTED BY`-�,.` - ----•- _ _::� DATE --------------- ------ -': BUILDING PERMIT ISSUED ...-'-.: '•.....-- TS -_ ADDITIONAL COMMENTS ---'---- - .......................... .-- - —� --'--'-- _.. - - ... at - ----------- - �- - D. Final Ins ection b P y: .:.. . _.. SAN JOAQUIN LOCAL HEALTH DISTRICT