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FOR OFFICE USE: ;i PLICATI ON FOR SANITATION P�RII�-'T ...................................-- 4 1 ICorsplete in Triplicate} This Permit Expires t Year from Date Issued Date Issued Application is hereby made 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. JOB ADDRESS/LOCI N , /�� -S �� J� .. .......... v_2 i..._.... f........................................CENSUS TRACT Owne'r's Name ,L - • - --------- - ✓. ---••-•----" Address .-.. S` if 1�-�� •---•-- 3��--•- i --.---------•---------------------------------- .....City Contractor's Name .-F._-r',4/-7 - License Phone - • ----- ---------------••------------ ......-----•----•••. Installation will serve: Residence-Apartment House Commercial 1]TrailerCourt 0 Motel ❑Other ................................ .......... Numun Number of living Number of bedrooms __- ..._Garbage Grinder ............ Lot Size i Water Supply: Public System and name - ......................................•.......0 1 rivate Q. Character of soil to a idepth of 3 feet: Sand❑ Silt Q Clay ❑ Peat❑ Sandy Loam•`C•t~ Clay Loam❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type..... .......... (Plot plan, showing size of.lot, location of system in relation to wells, buildings, etc. must be placed-on reverse side.) NEW INSTA!!ATlONa INo se tic tank or see a e it p p g p" permitted If public sewer i va' b!g ith n eet,}, ' PACKAGE TREATMENT 1 I - `1 [ 7 s SEPTIC TANK-[ ] Size.................. I ._.._._ ..�,�-. ,Uqu'd pth J57 lS ice G-. Capacity -------------------- Type -------------------- Material-------•--•- --- -=�`Nd. compartments ------ , Distance to nearest: Well ------.--__ 16wy� ;I .................Foundation . -••"-••-----.- .... Prop. Line ................ I LEACHING LINE [ j` No. of Lines , ---•- ---•---•--•_-_-_- length of each fine ,_.. .. .. To -- •---- tat Length it � - ��t � - •• •- �r��_• .__'f...................... 'D' Box ... -- ..... Type Filter Material .-.-.�._f...ir.. epth Filter Material .......... .-- Distance to nearest: Well ------ .---- Foundation ../4.. ...... Property Line ......I.......z�.. SEEPAGE PIT [ ) Depth ..---• Diameter _ Number •-•---- .............•- ----•-•-•--....... Rock Filled Yes p No Q iiWater Table Depth - Rock Size ----- .......................... Distance to nearest:Well ______________ ._.....----- Foundation -••-......_ Prop. line ...._•............... i REPAIR/ADDITIONPrev. Sanitation Permit --( .i .._ Date --•-•-----=------------•-- ) i Septic Tank (Specify Requirements) ............--------------------"w_•_•- ....._....-•..............................-.....---..... . Disposal Field (Specify Requirements) ---------- ---- -_- - .j,Q U - - .......................................................................... ......................---------__....----•--......---......._._....._........----__......._--•-•....._._.....•....... .. ..... .._.._._.... _ t' (Draw existing and required addition on reverse side) I hereby certify that I! have prepared this application and that the work will be dons In accordance.with,SM Joaquin , County Ordinances, State laws, and Rules and Regulations of the Son Joaquin Local H*Wt1k District.-Home owner or licen- sed agents sign Lure certifies the following: "I certify th t i the perfor c of the work for whirs ithis permit Is Issued; ! shah not employ any person In such.manner as to beco 0 0 's CtVTntpensa1Ion laws of Califprnia. Signed Owner (If other i -•---- ----• than awned FCW p DEPARTMENT USE ONLY APPLICATION ACCEPTiD W.. ........ ... . --- - - ----- - ------ ----------------•-•--- ----.-...DATE _--r .-_+ =:{ ------- 13LIILDING PERMIT ISSUED :. ...........--•.. .......... .......DATE ....--.. ------ ............................ *ADDITIONAL COMMENTS ....'.----• .......-•................_................................................... .................. ................................. ""•..............."•--"----.......--- --..-.-.......----- •----•-••-----.....----... .......... - -3 2 ! Final Inspection by: --- r . ---- ........ . ! --r--. .- EN Date�/ 7 . .Q.... ......... l -6 13ev• `>�l SAN JOAOEJIN OCAS HEALTH DISTRICT 8/7h 3M