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PERMIT APPLICATION FFR SANITATION P FOR OFFICE USE: Permit No. ------------------- � ,� _'Com plete inTriplicate) Date issued - - ----� - -- ----- -------------------------- ! This PermitExpires l Year From Date issued 1 the work herein r it to construct and Application is hereby, made to the San Joaq inLocal ` Cay District rn a No 549 and ex sting Rulestaind Regulations- pp application is made in compliance described. This app ' F CENSUS TRACT ----------- --•----------- t ----------------- JOB'ADDRESS/LOCATION 7 -------------------------------------------- --�-- - --------- ---phone _��-�-� - ..e Owner's Name l l� Cit - ------ ---------- --------------- - = 74# - Address 1Q/Q „' License # "-/a. � Phone ' i I ::.-d - r Contractor's Name __- --- - ------------ -------------------------------- ` Residence Apartment House❑ Commercial:❑Trailer Court lnstallatian will serve: , /�Q ` / i Motel ❑Other _-,. -------------- r Lot Size .- - --- -------Garbage Grinder Number of living units:.__._ _____ Number of bedrooms;-:: __ _ _ ,.w Private �.� Water Supply: Public System and name __ __ - ___ - Feat F1 Sandy Loam ❑ Clay Loam:❑ Clay Char'acter of soil to a depth of 3 feet: Sand'o Silt❑ Y ❑ Hardpan r Adobe X Fill Material _ .......... yes,type laced on reverse }side.) (Pl'ot1plan, showing size of lot; location of system in relation edofwells, buildings, available wmust ithin 200 feet,) 1 �� NEW INSTALLATION: (No septi tank or seepage pit per p / Liquid Depth ..--`�4y- =- [ SEPTICTANK'UQ Size-----74,'1-14-?4--- �a �. . A PACKAGE TREATMENT_ {..7_ - _ No. Compartments -----------• ___--_ Material-�8� `i Q Capacity _1a0 Type �, / �� -- - -- Prap. Line __f� V�-------� O -- ----------Foundation _.__ -- -- - - k k Distance to nearest: Wekl _____________ 4 Length of each line---.--- -- �._.-___ Total Length LEAGHINGLINE - [ - N&-of-Li = :, d,I/ 1 r _De th Filter Materia! _--_---I- 1 'D' Box ----1----- Type-Filter-Materia l f 4g p .41 i� Foundation _-_---� ---- Property line - �Q ==` 1 . Distance to nearest: Well -- � { ,. No;ID . _� .� [� Rock Filled Yes �J DiaMete ";�� Number ' j SEEPAGE PIT Depth ___. k't xt t i / e Rock Size - ��” j --------- Water Table Depth .-•---------- g � � -�.. dD� Pro Line _�-r1-. -�------•- i U --------- Fotjndation p Distance to nearest. Well _______� ----- Date - ` --------------------------) REPAIR/ADDITION(Prev. Sanitation Permit# ---- ,�-------- _ _ -_-- - _"•- ------ ' pd -- �` Septic Tank (Specify Requirements) --------------- ! _ _ P, r Disposal Field (Specify,Requirements) ----------- •�. ----------- -------------- �. I ---- ------ -------------------------------- f _t 4 ---- --------- S ------ -------------- --- ------ - � ---- (Draw existing and required addition an reverse�si e) .�� Chereby certify that I have pro app lication and that the work will lie done rn accordance With San Joaquin Caunty Ordinances, State Laws, and Rules and Regul�citions of the. San Joaquin Local Health District. NY owner or ricen- y sed, gents signature certifies the following: p y erson in such manner "1 certify that in the performance of the work for which this permit is issued, I shall notes to any person as to subject to Workman's of California. an's Compensation laws t of i Owner E Signed ------------------------- p Title - _____________ _ . 5 BY (If other than owner) t } FOR DEPARTMENT USE ONLY F L i ------------------ DATE "s ---DATE - -----., f APPLICATION ACCEPTED B ! --- - BUILDING PERMIT ISSUED --------------- ----------- = ` - -----==----------------------- - ADDITIONAL COMMENTS ---� ----- ------------- ----------- ------------- ------• '-- �- --------- ' { - �1 ---------------------- - -- -(.1 - - ----- ----- /---- - ---- �� to _____________________________________-__--____--_._._--___ _--____ _______---_____ ^ 3 ---------- Final Inspection by- -------------------------------- - �'"--• .......- - ak SAN JOAQUIN LOCAL HEALT DISTRICT _ c u 0 1-'b8 Rev. 5M