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d'?� rt /�:?� .9;iwY .1-,a..Y' 3":i.- }�-7 n' ti��,, LL.X; Y,?!st t»'+rtw?' .- ..s ,_ • +.'..«.,r.' - x FOR OFFICE USE: m APPLICATION FOR SANITATION PERMIT ............. .................. p P Permit No mlefe in Tri (CoTriplicate) ,^ Date Itaxted ...................."..................."... TMs Permit Expires 1 Year From Dela Isswd "}µ Application is hereby made to the San Joaquin Local Health District for a permit to construct and inVall thea W described.This application is made in compliance with County Ordinance No 549 and existing Rules and ----yyam� � '= JOB ADDRESS I p��J .��.- .�G... CENS113 TRACT �' Owners Name .._.. ... _.. Address co. 5 - .. city Pf,an. �1 < , ..G -L:... se toF /.��.3J Z-thane ^ . Contractor's Name....-_-. Lioen . :. ......... Installation will serve: Residence Apartment Hou 0 Commercial Qurt Trallrr Co Motel Q Other... .. .... ... .. ..... Number of living units: Number of bedrooms ............Garbage Grinder ............ Lot Size ... _ -� PtitroN �.. Water Supply: Public System and nam. .. Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Q Peat Q Sandy Loam❑ Clay LONIft Hardison❑ Adobe❑ FIII Material i �" � If yes,type ...... . y r? [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pbced:,on NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within'200,fMt,) ;a r Liquid PACKAGE TREATMENTSEPTIC DopNt ` _ [ l � ] Size .............. My Capacity .................... Type Material...................... Na. Compartntenhs Distance to nearest: Well .... ......... ............:...Foundation ..._.... .......... Prop:Line r - � .. ". 3 LEACHING LINE [ J No. of Lines . ................ ..... Length of each line.. ..._............ ..._ Tocol length 'G' Box ............ Type Filter Material .......Depth Filter Material Distance to nears t: Well'——.... ............ Foundation .. Property Llrte SEEPAGE PIT ( J Depth ........... ..•...- Diameter ...-............ Number . .: .........:. .....-. Rock Filled , Yes Q' Water.Table Depth ......... ......................................Rock Size rr Distance to nearest: Well .... Foundation data n Prop. Line -t ON Prev. Sanitation Permit!f .................. ...................... Date .-----•--------- ---- -- --) N: REPAIR/ADD! $ Septic Tank (Specify Requirements) .........4-- ........................................... 7,"G ...... ........•-.. •-•-•-• D, I Field (Specify Requirements) x ............... -� -r ' -... .. u- x ( raw existing and required addition on reverse side) 1 hereby certify that I Irdw prepared this application and that the work will be done In accordance wltls StwsJes�ls TM F� County Ordinances, State Lows, and Rules and Regulations of the San Joaquin Locat Health DlsMcf. Hants ew"W orNpti• _ sed agents signature certifies the following! "I certify that in the performance of the work for which this permit is Isswtd, ! shall not employ any Person in stsefr utetllsN as to become subject to Workman's Compensation laws of California." sr •y rTr . -•- • Owner Signed .. ......... itle.._--- . .----•__ B ....(If other owner) r 3 +� -FOR DEPARTMENT USE ONLY K APPLICATION ACCEPTED BY. m z ,1................... ...... ..................................... DATE rl BUILDINGPERMIT ISSUED ...... ........................................................................ ...... . ........... ...DATE ADDITIONALCOMMENTS .................. .............................................._......•_...............-. .._.-.... .......... __ _... ................................................................................................ . .. .. ........... .. .................... ........................................................... �... ._.....� ...: �. . .:.. ...Oslo . ................ ........................................... ............. sFinal Inspection by: - ER 13 2L 1-6n lieu. 94 SAN JOAQU:N LOCAL HEALTH DISTRICT 8!711 3M yd4+ .. -. _ ... ._ - -.. .. .hT.... - � .'_t..... .-•..wr_... .� ,aF ..,c.:.(�•,rvz.: ,. -�` •Ed$:'i�`KF�.e...3�1��SL