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GF-iCF USE: �• F7 APPLICATION FOR SANITATION PSRMi Permit No. .. �. rOR 7 (Complete in Triplicate) lz :,. ......7 �7.............�. L ..tJT Date Issued ...c -• -'• `�r ! This Permit expires 1 Year From Date Issued . .......... .... ... I. ....... ..,,. .. ....... L�{�j� �r�� /� ,:.-a?kation is hereby "jade*r The San quin Loccl Health District fora Permit to construct and install the work herein escribed. +his apoiicction ism �m Ice with County Ordinance No 549 and existir•g2uIQs and Regulations. �C _ — .�,r4i2Avc� ��N US TRACT, C�,4ek-•.i7•-K��/c`.c ADDRESS/LOCATION .. }..,, f.4--.f�N. 1 -a-- ..{ L... ....:�...... Phone-- y -XJ -..S-_L------- �. Owner s Narre ..�.L_�.-`•-L ------• - �_ C S �7 �•-• 1 1 Address ._ ... one • ,l-� I.ontractor s Nam -. •-L.�-I� CT ' !nstallation will serve: Residence Apartment Houser Commercial railer Coin ❑ ❑ Motel ❑Other Ac GSE Number of bedrooms _ .---Garbage Grinder --.-'-- Number of iivinq units:...-. Lot Size- .. __Private � Public System and Home ------------------•-------•--• ------- -...-------_ ._------------- -- Water Supp'y: Sandy Loom Clay Loam ❑ - Silt Clay ❑ Peat❑ :horaCat of soil to o depth of 3 feet: nand ❑ ❑ If es, e ------_------------------ Hardpan ❑ Adobe ❑ Fill Material --- ----.. y type ro wells, b P!ot plan, showing size of lar, {acarian of system in relation uildings, etc. must be placed an .reverse ;ide.l wer is available within 260 feet.! NEW INSTALLATION: (No septic tank or seepage pit permitted if public se - Liquid Depth,,.i�.- -----..,----• e 'ACKAGE 'REATMENT r SEPTIC TANK QQ , y- No, Compartments •_2 --•--__... Capacity/j�Q_, Type. l�L�s6.�+a.•- Materia . ` \ Foundation .A o.....----•- Prop. Line . ^5-...--- • Distance to nearest: Weil v-- '- ^^ r ��.._...._ Total Length --�. (1- -•-...._ --•-- j -- Longi of ea tine l LEACHING LINE r � No. of Lines � -•- ` ..------_— ---..._--- t �Z r ---- th Filter Material - -7 _ p D' Bax .-- -•••--- Type Filter Materiol� ----.. � "eP ,�II��++ , Line 1.5..._ G�rte- --- Property ..._ r Foundation ----• r III Distance to nee Well �C. No111111111 (� S SEEPAGE PIT Rock Size t` _�- Water Tabie Depth ----------s------------•- ••- Foundation --•------- Prop. line -------------------._ pittance nearest: Well ...- •----- - } ..._._ Date __- --•---- prev. Sanitation Permit # REPAIR/ADDITION - .. $Q Tank (Specify Requirementsj ----••- --' ..--------- - - ------------------------- Disposal Field (Specify Regv,remerits --..-- ----- ...---------- -----•- ---- --.. ._..-•-•---- -- - ............. -• !Draw existing and required addition On-r-0 arse side) ilcation and that the work will lie done in accordance with San Joaquin ? hereby certify that I have prepored this OQQ uin Local tfeallh District• 1{onte owner or (Lc*an- County Ordinances, State Laws, and Rules and RegYiallonz of the San Joaq exon in such manner sed agents signature certifies the following= permit is issued, 1 shall not employ any P "I certify th the performance of the work fo hich this p as to becomes bject toyi►or ^an's 4ompensat n laws of Catrhrnr Aef .., ne .. ... •-• _ � � --- Title ._ ..... - �1♦other r an awnert ~` FOR DEPART.ME"T U5£ ONLY ---_ DATE ------ ... ICAACC:PTcD aY ._ ':'� ........ ..... ..._-.� .. ... .DATE...., ...-...................__............ �ijILCING PcRMIT :S51i>:s7 .... r ._.. ... .... .... ......-...., . ........... .... ............... ........ ..... .... . .... ., .. ..........,..... aDD+IT;CMAL COPhtA'ct�+5 ....,..., ..... ............ _.... . ... ..................... ... .. . _. ......._ ............... -Rai insaeaso� by: ..-.._. SAN '—EALTH _ e..