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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 75 ----••-.--• ................. .(Complete in,Triplicate) Date issued • ... . �. �. ued .:. .. ..... Thii Permit Expires 1 Year From Date Issued County Ordinance No_ 549 and existing Rules and Regulatiosts: Application is hereby made to the San Joaquin Local Eth Ce District for a permit to' construct and install the,work herein p`pp location is made in compliance w described. This app ' / j(ENgIJS TRACT JOB ADDRESS/LOCATION .. ..._ .- .--. o ....... ................•. . -... - Phone - �.., �- i Owner's Name ......_. .. - s�/1�- �t.�'P._..-..-�------•-•-..__.._. �•-- ' �l--•-_-_-••-•-- ..--_•..- City - ZA Address ...-r -�,Q•..... - License #..97/:- A9ff Phone Contractor's Name v - si r Residence�Apartment House❑ Commercial ❑Trac+ler Court Installation will serve. rt '❑ � Motel ❑other ----------------- --•-------•----- -- - - - f Lot Size Q. __ ..... ........ i Garbage Grinder ��--- Number of living units:.-.�.-- Number of bedrooms �--•-•• g --- --•private Water Supply: Public System and name ----- ---------- Clay Loam Character of soil to a depth of 3 feet: Sand)] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------ L If yes, type - ibuildings, etc. must be placed on reverse side.) (plot plan, showing size of lot, location,of system in reldtion' to wells, sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or seepage pit permitted if.p .... Liquid Depth . -•-----•--•-,•__. PACKAGE TREATMENT ( ] SEPTIC TANK 0 ` No. Compartments Ja /Jdr _ P Material- �� Capacity TYpe/" PropLine ••-•-` '.:_..�..... vQ 4 Foundation --lO-•--...... .. • 0 Distance to nearest: Well . .-.. -J_ *� i Total Length -44e.-411-11 -.._-.__ . -•.- Length of each line...-�- - LEACHING LINE No. of Lines �i i �[7e th Filter Material �r�-----�•-•----------••--._`... - D' Boxy f.- Type Filter Material� � yy Foundation- -- ---- ----- ----- Property Line Distance to nearest: Well -l. J � Rock Filled,, Yes, No ll] SEEPAGE PIT Depth .A"f Diameter r s -....__ Number ..__. . ...lf_..... --- / ........ '0, 5ixe�.-. "^'--- ----•-----•:...... �• �� } Water.Table Depth _.._ +;�---------- . - .-- Prop. Line ••---•-••- �b --•-._Foundation .. ... ........ `�_.----• C _-.---- v� Distance to nearest: Wel! ._._�-�"------------ ., . Date ---- --------- ------------------•) 4 REPAIR/ADDITION(prev. Sanitation Permit# - .:_..----•.............. Septic Tank (Specify.Requirements .. -- -------------- ' ................--_..--- - - Disposal Field (Specify Requirements -------------------- ------- -------- ---_•---.--, ----------------- ------- ------------ �..._._.. _..-._. ............. (Drtiw existing and required addition on,reverse side) ne in-kiccordance I hereby certify that I have preh Son Joaquin pared this application and that tfi San Joaquin LotaoHeaftfi District e work ;will-b'e d Hometowne+r or licen- County Ordinances, State laws, and Rules and Regulations of the sed agents signature certifies the following: ny person in such manner { ' "I certify that in the performance of the work for which this.permiti issued, I shall,not employ a as to become subject to Workman's Compensation laws of California. Owner Signed ......... _.-.._._.... B -- ...---• -- Title . ,f�.. - a—�� I ' ?(jither than owner) ..FOR DEPARTMENT USE ONLYDATE.....-- ••----------------• �-..._...-.._..-.......� DATE ..-.. ._..._....._..._._ . _.... ..._-__... APPLICATION ACCEPTED BY ..-._..--._ -- -- • - . BUILDING PERMIT ISSUED .--- ADDITIONAL COMMENTS - --------------- ----- `_.. .._-._._.. -..... .. ---_ _ ............. _ -•-- ✓ r - --------- ------- ..--.-...._Date ......_. - Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 .K