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FOR "ICE USE:% APPLICATION FOR SANITATION PERMIT Permit No. -------------------------- - -------------------- (Complete in Triplicate) il /-_— __ _ - Date Issued _ --`�---'"- .This Permit Expires l Year From Date issued i----------- -- t I ocal rict for a ermit to ct and l the work herein Application is hereby made to the San Joaquin with Count alth ytordinan a No' 549 and existing g Rulestand Regulations, described. This application is made in compliance P I is Sr � S�1 �iRg ----- CENSUS TRACT /�_ JOB ADDRESS/LOCATION __/ _ 4 �, phone ---------------------------•-------- 0 - Name i� g -------------- � ------------ == --------- Owner's �.� 1 Address !l�®c' - k -�----- -- City ir r ------ Phone � C1 �- - -- --- �� ---- -=----- ---License'# Contractor's Name -_I ?�1� e�----- ' 1 Installation will serve: Residence (Apartment House�❑ Commercial ;❑Troilei-Court iQ I w -- ji Mate) ❑Other Y `} ,,- ------------ tY Number of'9living units:---1-- -- Number of bedrooms -- - Garbage Grinder ----- Lot Size ---_----�- l ❑ ---------- Private ly: Public System and name ----- -t--__r- ---. '- , . f t' Water Supp Peat Sandy Loam [� Clay.Loam ❑ Character of soil to a depth of 3 feet: Sand'[�/Silt fl F�Clay -❑ El Character _ -."Adobe'❑. Fill Material _1�-Q--- f.ye ,type ---------------------------- II�� --Hardpan[]- I s buildings, etc. must be placed on reverse side.) (Plot planI showing size of lot, location of system in relation to wells, !� • pr P.. Liquid Depth -_/-- -----.----- # NEW INSTALLATION (No septic tank or see age pit permuted if public sewer is available within 200 feet,) i PACKAGE,TREATMENT [ ] SEPTIC TANK } size---- - - P �Qh�R�rfc. ' �; Capacity _ Type*E-C_AST�Material --------. No. Compartments r � id Distance to nearest: Well ----��----�----=-�-�-�--- --Foundation _._�------------- Prop.-Line -----�--------------- . - i i.+r.... ...._ 1W.- Il � ' � ' 11 . Total Length I LEACHING LINE Il.J No• of lines - -----J------- Length of each line-__._' ,� r .t /. II D' Box __/-------- Type Filter Material --------Depth Filter-Material -+----1-�-- '; t jU Property Line Distance to nearest: Well -_� --y'"`= - Foundation _-_ ___------- --- �� R Im p „ } ------------ Rock Filled Yes ' No Depth .3�0 Diameter,8_X l�--- Number --,-�4--, -----rte. - [ Pv Rock Size // :.-=- I WaterTab1e Depth ------------- ------------------ / ----- ---- ; Distance to nearest: Well 1 TMR0P--___C'- -Foundation joQ ------ .... Prop. Line ---.------- ...... IgDate ----------------------------------) REPAIR/ADDITION(Prev. Sanitation Permit# ---=---- - ---- --------------------- --------------------I------------•-----------.._- --- Septic Tank (Specify Requirements) ------------ --------------------------------------------- r r ------------------------------------------------------------------------- Disposal Field (Specify Requirements) -_---------- ------------- ------------------- -------------------- -- ----- 9-------------------------------- -------- - — - ( -------------- I� }Draw existing and required addition on reverse-side)e)Y -•--� �-� l` I herebyl'certify thaI have prepared this application and that the work will be done in accordance with San Joaquin al Health District.-Home owner or licen- County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Lac i sed agents signature certifies the following: . "I certify that.in the performance of the-work for which this permit is issued, I shall not employ any person in such manner . as to bee s Lblect to Workman's Compensat' n laws of California." ._ f --Owner Signed Title ---- ------- --------- Ti BY fes/ other than owner) FOR. ARTMENT USE ONLY _ -- DATE ----- APPLICATION ---1 3 BUL DIN TION ACCEPTED BY �_R--0--------------------------- - - - - -.--- --------DATE ------------------------------------- ----- G PERMIT ISSUED -=�--- ----- --------------------------- ------------- - --------•------- -------- ------ ------- ----i-- -- ---------------- ADDITIONAL COMMENTS ---- -------- --------- - k _ ,- _ i, _ ---•------ ------------------------- -----------�i -`- -- - - __ ------------------------------------------ ------------------ ---- ----------- Date --- -- ------------------------------------ - / --�--6 ------------- --------------------------------------------- --- ` Final Inspe _ -• -- -------•�--------- ------- -------- v SAN JOAQUIN LOCAL HEALTH DISTRICT �I - ' i9 E. H. 9.11 l- ¢$ Rev: 5M _ -