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II ' FOR OFFICE USE: i APPLICA?IMRON SANITATION PERMIT 3 Permit No. ..7......��. .• ..... �. .....---•-• .- .�._.3-.4--.. J 3 ii {Complete in Triplicates ....................................................... _. Date Issued .. 0./ ,73 it This Permit Expires 1 Year From Date Issued .itruct and for a d Application is hereby inion isa the Joaquin e plian e with County tOrdinance No. 544 and existing Rulestalnd Regulations- described. This application � � .. ................ Q f ........-.. .... . ..... . ........... h' .--..........CENSUS TIZACT ...., JOB ADDRESS/LOCATION .._-'i .......... . ....... r t ................................... G� l7 -Z ------ ....... ............. ne . Owner's Name .......... ..-- .� k. ...... � ffi.)��_!._ �lr:!.. . City -v_rt�w!� •---- ............. Address - Phone err. .. �J License # . .7.1. .... a, Contractor's Name . . _ "'� installation will serve: II� Residence partment House Commercial ❑TraiEer Court 0i Motel ❑Other c�. ._.Ga�'bage Grinder N..�...... Lat Size __ -x.1--- '•--.:--:...-•-....: I Number of Iiving�units:_:--- __.. Number of bedrooms ..-_ Private ❑ I' ••----... Water Supply: Public System and name ............. i` Peat Sandy Loam ClayLoam ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ❑ ,ese -----------------.._.-.. i � Hardpan ❑ Adobe' F I Material ..-..._... If y type {Plot plan, showing size of lot, location of system in relation to wells,_ buildings, etc. must be placed on reverse side.) I 9 NEW INSTALLATION.___(No-septic or,.seepage.-pit permitted if public sewer is available within 200 feet,) -.. � iae.,�.---�-�,S�X••�------- ...----- Liquid Dept ... /Z. PACKAGE TR I:ATMI: IT [ ]i� SEPTIC TANK -. Capacity :� - • TYPes- -.%..- - --• Material No. Compartments •............. r Foundation .. 10_r-..._...._ Prop. Line ..�.........---•.-J l tante to nearest: Well ,___.__ --• 0 { is Length of Clyne - - .....---•- Total ..----------•----•-..._....- d I LEACHING LINE [ �No. of Lines -- T t j ideg i � U ----... -- ........... �._ T e Filter'Mate iol "" Depth Filter Material 'D i�Box -N YP � . I - i � Q. _ ... Property Line _ 1 w. Distance to near st: Well _.;.1' -- .! ------ . Foundation -... _-. _ - •-•---••--•-........ t ' Number ----_--------�----------. Rock Filled Yes No ❑ SEEPAGE PIT [t, €Depth _- .-- --- - Diameter 6 Ji i'I _...�..� . .._..Rock Size !2 .X_. ....._.. T ,Water Xable ------ Ca .. .._ a/ ipance,.to_nearest:.Well !".. .- ; ...Foundation Prop. Line Date -------------•.) .t- REPAIR/ADDITION(Prev. Sanitation Permit�# ----------- """ ii of Septic Tank (Specify Requirements) ....................._.....----•---••••••--•�------•-•--............... ... -....- i .� - -------- ------------........_.-•- Dispasal Field {Specify I Requirements) ...... -- • -------" = ..... �} . .� ................ #..-. -------• ------ ¢ i �...........................(Draw existing and required addition on reverse side) 1I - will be done in accordance with San Joaquin I hereby certify that I have prepared this application and that the work CounOrdinances, State ,Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents-signature certifies the-following: arson in such manner ► "I certify that in the perfo6-unto of the work for which this permit is issued, I shall not employany p as to become subject to Workman's Compensation laws of California." F ' Signed ......... ..... . ........ ............... Owner u -------V By .. .. .. .... ..•-{If other than. ._.. r FOR,DEPARTMENT USE ONLY_ APPLICATION ACCEPTED i BY ... ... . .................. ---------...----•-•--••---....._._ . . . DATE ..��-��.�3.............. BUILDING PERMIT ISSUED ... ` � ................:.........DATE ........................................... ADDITIONAL COMMENTS " ........... .. ....-••.........!... ..--• •-••--• .................. =.... �. . ...................................... ... ................ ---•-------•-- •......:................•••---• .....-._ ----------------- ........ .Date . Final Inspection by: ........ QUIN -LOCAL HEALTH DISTRICT 7(723M 1 .. IA ?LL 1 .te b_.. A'A