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FOR OFFICE USE: APPtICA ION bolt SANITATION PERMIT Permit No. .... ................ ..... (Complete in Triplicate) -y fLr •.............. 6 - •-•-•• Date Issued : ............. ............................ ..._..._-� ti ' This permit Expires 1 Year from Date Issued - .......................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the re�n • This a ication i made in compliance with County Ordinance No. 549 and existing Rules and Regulations' described. p ..CENSUS TRACT .......................... DDR /LOCATIO ..c,4_J-..... ...- '... JOB A ..........:................... ._Phone ��4 Irl 1. .� . ....... .................. ..._... Owner's Name -- •-• -- � r ....... ._,Cit Address . 8 .. .. Phone --._. ... ....License� ... Contractor's Name _- ial oTroller Court �] Residence Co Apartmen#House ] Commercial installation will serve: Other -. ' Motel ❑ -'_..... ............... Garbage Grinder Lot Sizer x l' Number of bedrooms .-�--•-- - Number of living units:-.-_.C__.._ r ....•.... ....Private Water Supply: Public System and name _..• ---- S Sand ClayLoam Silt 0 Clay 0 Peat 0 Sandy loam M. I Character of soil to a depth of 3 feet: ❑ I# es e. Hardpan[] Adobe fl Fill Material ............ yes' ............... .... I laced on reverse side.) size of lot, .location of system .in relation to wens, buildings, etc. must be p {Plot plan, showing + it permitted if public sewer is avclltible within 200 feeM I 1 f NEIN INSTALLATION: (No septic tank or seepage g p r Liquid Depth q•'•Y.......... y TREATMENT ( ] SEPTIC TANK� ] v...--.,+r PACKAGE Compartments 4 _�----- /�Qa �� Type ..__.. Material. Y1� C No. Cam ....._. Capacity c Foundation Prop. line __--�® nearest: Well 1-a�?... __.:. �� d pistonce.to --•� ' Total Length 1 r -... Leng#h of each line..--.... .�..�..-..._ LEACHING LINE t I No. of Lines .... -J- --•• �r .......... `-;•Depth Filter Material ......... �� 'D' Bax '�TYpe Filter Materi sl�t. �y ---• ----•• a Line . Property ..... ...... Distance to nearest: Well 0k_.�-'--..� .(J�- Foundation ..--...----•----•-----• . Rock Filled Yes a No X 1 '�••---•. Diameter .-..�_�•-- Number ---••-..--..�:.-.... ---• � SEEPAGE PIT ( ] Depth :..�5 --.--Rock Size Water Table Depth _..---- - -Q----�'•----••---7*-------- � Distance to nearest- Well d Foundation ____.. --.. ..... Prop. Line _.. .®..........- Date REPAIR/ADDITION(Prev. Sanitation Permit. -•-----••------- • -------•....•-•-• Septic Tank (Specify Requrrementsj :•-----------••--- •--••... •---.. ---------------•--- .------- Disposa) Field (Specify Requirements ----••----•---- t ...._.---- . ................... ........................Y.......... -------- . {Draw existing and required addition on reverse si e ne in accordance whh Son Joaquin 1 hereby certify that I have prepared this application and that the a Joaquin��cpi°Healih:Di trio. Harte owner or 1 cen" County Ordinances, State Laws, and Rules and Regulations of the sed agents signature certif'ses the following person in such manner "'I certify that in the performance of the work for which this permit is issued, 1 shall. not employ any as to become ubject to Work n's C enLati n laws of California." _ ---••--•----- Owner Signed ----- - -'•---------- - � w_1 -------•- Title -- -- - --- ------- .-- --- - -....--......._ -----------• (If of r than owner) ARTMENT SE ONLY ' DATE---------------- ....: d�` APPLICATION ACCEPTED BY .--- - 7DATE ---- BUILDING PERMIT ISSUED ..... .- ..-_. .... ADDITIONAL COMMENTS --- ---- ------- - - ---------------•-----•----. ---------------------•------------ ------ - --------- --------- ------.-- ..--.-..... --_.....---._.•---.. --=................ . • ------•----------------- - ------------- ...... ... t..... . ...... . ...... -------Date Final Inspection by: -.-- --- --- --- 8/74 3M M 13 .24 1--613 Rev. 5M SAN JOAQUIN L HEALTH DISTRICT