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77W .1 FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT .. Permit No (Complete In Triplicate) t' ...... ................... ... , ... ....... . This Permit Expires 1 Year From Date Issued Dote Issued AppCcation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work I►drein t �, r;.a, das Abed This,application is nide.in compliance with County Ordinance No. 549 and existing Rulas and ksgula ions: =t JJS AUDRE55lLC?CAT 1-&, : "v .......:.:............................. .CENSUS TRACT a r ........................... Phone Addrnsa .....�%ft.. G .. City ..... ... Contractor's Name :_-:...(c,o,(1rss,a.c.a�... _. ---.�.Liconss 1040 ........ Pfiono _ installation will larva: Residence partmentHouse❑ Commercial ❑TrallerCourt D Motel❑Other tdumbsr of!iving units,..... Number of bedrooms ._::3....GarbageGrinder ............ Lot Siza .. .-.:. - .- .-.._._. Water Su I soil S stem and name .. ..............._..........-........................ ..-. _. Private , PP Y Y_. ..__ r of sol to a depth of 3 fest: Sand❑ it❑. Clay ❑ Peat❑ Sandy Loam ❑ Clay Liam Characta Hardpan _:Adobe❑ Fill Material ............If yes,type (Plot plan, showing size of lot, location of system in rotation to wells; buildings, etc. must be plead an. n reverse skis? �dsr'� NEW INSTALU►Ti0N, (into septic tank or seepage pit permitted if public sewer is available within 200 fact,); P�IE'KAGE TRt TMENT SEPTIC TANK �'' y Size.::....._...... ...... liquid Depth f 7 �� J �. , ' Material..................... No. Compartmen�s capacity .,.:. ..: Type _.._...... - Distance to nw:arest Well ..............................Foundation ...................... Prop. line LEACHING LINT [ J No of Linos length of each line............................ Total Length .................. 'D' Box . ... ..- Typ� Filter Mo'enal ..............Depth Filter Miateriol :_ t _ Distance to nearest: Well .- --. Foundation .................. Property line :.n1 v ;,, .. ... . - Ruck Filled Yes No a, SEEPAGE PITr�[:J L'apth -_ Diaineter Number .-......_.- ❑ { Water Table Depth ..............................Rock Size ....................... ...... ; r� Vi ofr - Distance to naarost. Well ...Foundation .................... Prop. Lina , t?IyPAIR/ADDITi IN(Prev.Sanitation Permit :.:.:::.................................. .. Datc ....................................i ;. Septic"Ta7rk (SPac;f3' Requirements) ........................... ..... ......... Disposal field (Spedfy rRPquirements) :. •.... ......................................... tt•��, � �i existing and required addition on reverse aide) l gr_ tysert li,�wve pi this al. pysiteatitin assd that the work will be derw In 4 ' �rr'anee wi9ir gt=a �1dd ,�3lofi Laws,a itukvs and Regulaations of the San•Jiioqutn Local Health Lrateitt iiernm w�itssp Px Il�sao- 'st {t)•,yse►�in,li�,6 !of fbta`wwi(for which:this permit is issued, I shoiI not esnpley any,parzon it, steels coast 2tse t�ko�� i9 orerrrson'a C.osegonsa9fots lug ai!California:' . . _ gosh kA Owner .._. .._- „ ?itle �!Ow than owner) DEPARTMENT USE ONLY r `3 FOR y ;APMCATION,ACCEP.TED 'BYfl,,�r,�_i.�-a^—, -----............................................. ................ DATt:_ BUILDING+PERMIT ISSUED ........ : ...................................... ' DDrTIC>h1AL 0OM(4XNTS _.,- _ .-._.... - ......................... ................................. DATE a r - .. ............. ...... .... ..--... .. .................... ........ ........ .. ._.._ o Final Inspection icy,..,.'��="-�x�..., ....................... ....................._......,-............_.__....._.-....._.Data. ' SAN JOAQUIN LOCAL HEALTH DISTRICT fi r.H. 9 1-'66 Ruv.�N!,