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c fOR OFFICE USEi APPLICATION FOR SANITATION PERMIT Permit No. .......................................................... jtompfoo in TrlpllcoW ..�':..................... This panni!Expires 9 Year From Data WOW pots Issued - ........ . . . 6 . ............................................ Application is hereby made to the San Joaquin local Health District for a permit to c+ommkit and Install the work herein ' described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations SOB,ADDRESS/IOCATIO ,(1._-/l- .-_-�•- CEN5IJS TRACT Owner's Nome ..... ...... - ................... Address ._._...............' Q.(�-`'. i.. ._ ,/ ..✓ ..•....City ..... .t' 2 �C�- license# ........... he ........... Contractor's Name ... .............................._..._.• .....------•. Residence Apa {� Instollati .will rtment House Commarda!]]Trailer Court ❑ I� .PIC, Motel ❑Other....................................... Garbage Grinder ............ Lot Site •- Number �114�?naguni?t.*- . Number of bedrooms .. •- g { Water Supply, Public System and name ............................---......--------------- ..-..y -Prhrate� I Silt Cloy Peat❑ Sandy Loom❑ day loom ti Character of soil to a depth of 3 feet: Sand C1 ❑ y ❑ Hardpan❑ Adobe❑ fill Material ............If yes,type............... ............ r tc. must be placed on reverse side.) (Plot plan, showing size of tot, location of system in relation to wells, buildings, e C NEW INSTALLATIONr (No septic tank or seepage pi-t permitted if public sewer is available within 200 feet,( SEPTIC TANK Size..... ............ Liquid Depth-..,....................... PACKAGE TREATMENT ( ] Capacity� ll TYP° MaterM-.. �. ... No. Compartments -.. Distance Yo nearest, Well ._. . L -- Foundation .1 Prop. line . --- �- •- Length of each line. Total length •� '.EACHIN_G LINE No. of Lines ........ • ••...... „l�'1./? ......... i 'p' Box .....1-... Type alter Materlah09C. G44et� Iter Mr+t°rial E undation ope N . .....No.....Distance to nearesti Wellr Line . _ 01ameter .... ........ Number ............................ Rock Filled Yes Q CI SEEPAGE PIT I Depth .................... Rock Size - Water Table Depth ......................... ..................... ......._...._................. Foundation ............ ....... Prop. line ................... 11 Distance to nearest,Wall ........................................ REPAIR/ADDITION(Prov. Sanitation Permit# ..............•••......................... Date ..--••--. .......--. _...... .j .„ Septic Tank 15psclfy Requirements) .................................... ......_............................. .......... .....-. ... ....-�.... ...-•• ................................. Disposal 1`1016 (Specify Requirements)` ................................... _t...... _. .... . ...:..�. ...................................................................... ......... (Draw existing and required addition on reverse I hereby cerdw fy that l have prepared this application and that the work:will be done In eeterdance wilt► San JoogelI. i County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Haahlr District.Home owner ort1cm sed agents signature certifies the following: Person in such mariner "I certify that in a performance of the work for which this permit is issued, I shall not employ any p F as to becomes Oct to orkman's Compen do aws of California." ° $, ned ..... ..... ...................... Owner 9 ..... Title ....................................... .................... ......... ••........................... t (if other than owner) P FOR DEPARTMENT USE ONLY y DATE ... .. ..... ::.. APPLICATION ACCEPTED BY .............. . ..-.....-...... .......--................... ..........-..:...-.-........_._..... ATE-. ................'-....: BUILDING PERMIT ISSUED .... .� ......... D f ADDITIONAL COMMENTS - �G ---..C.� ........ .. .�`.7. --.............. ............................... ........ ............................ .... ... .... ......,.... � ✓ - _ ...........Da a .. 'D TRICT.. Final inspection byt � - Dot. . a 13 2L 1-60 V. ' SAN 10AQUIN IOCAL HE�►lTH S 8/7� �