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�....• �"FOR OFFICE USE: FOR OFFICE USE: <br /> rr I APPLlCATIf-N.FOf-SANITATION PERMIT "- „ ` <br /> �I ;a- <br /> I----- -- - Permit No.--- <br /> -------------------------------------------- -- <br /> (Complete in Triplicate] ---�---�---- --- <br /> -------------- - �I----------------- --------------�`- Date Issued --1-------7---7f <br /> r <br /> -.--.____________I�_______________________________ l..__ This Permit Expires 1 Year From Date Issued <br /> „1 :�w <br /> Applicatlbn!l�is hereby made to dile San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION.,=._..h 1 -_-- - -�---- - - --- ----- IL--- CENSUS TRACT._ <br /> Owner's -- -- ------=---- _- - °n <br /> Nume------- _-� --=------- ��� tl--_-r'1-- e c <br /> x G <br /> s <br /> . h <br /> I l/ <br /> Address� 'f-�-�6a1- �---•-------=--- -- �C.`-.r�7-�>�_ __ CitY-���----_-- -- ---------------------Zi P!Contractor's Name.--- ' 1_'_s_1 - �% License# 7 Phone # _. <br /> Installationi will serve: R-dsAen-e j Apartment Hause.❑ Commercial El Trailer Court E] <br /> g ----------------------- <br /> -1-.:: <br /> - ------------------- <br /> I i hotel ❑ Other , .k. _ * + <br /> mberof�l�iv.ing units.---- <br /> Water <br /> Number of bedrooms_ _.__Garbage Grinder__.,.__._ --Lots Size___ ----------------------------------- <br /> Nug _ <br /> 1 � _ t : _ <br /> Water Supply: Public System and name:.----:- ------------------------ --------------------- ------ ---- -------------: --- --------Private <br /> Character of soil to a depth of 3,heet: : Sand ;Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ # �� <br /> I Hardpap ❑ Adobe Fill Material--_--=-- --If yes, type----------------- -------------- <br /> f dE ip. J <br /> [Plot plan, showing size of lot, location of system in relation to wells, buildings,'-etc. must be placed on reverse sidl.] p4 <br /> NEW INSTALLATION: septic ta_ nk or seepage'pit permitted 1f public `wer is available within 200 feet,} /J" <br /> ©' <br /> 4- , �, - _-- Liquid De th._. <br /> PACKAGE TREATMENT [ ] SEPTIC TANK" [-'•]ry `•. Size- -- _ -- _ �- - - .---_-�� -,---- P . ------,^-- <br /> i <br /> Ca aci i �7 e G MateriaL __ __w':. No. Compartments <br /> P --- -------- <br /> Type <br /> Distance.to nearest: \kelt n __ C3 ._ -- -Foundation Prop. Lin d` <br /> LEACHI ,GIel <br /> tINE: [ ] No. of Lines.,___ I: --;� L�e'ngth of each line.___ ] 1 _-- ''Total r'ngth ..__----------------------------- <br /> Material. <br /> _ <br /> :' i <br /> D' Boxy --..Type Fitt r Material 4 ?�! _ Depth Filter Mat iaL__-_ _d� = :- <br /> 1 Distance to nearest: Well ;-14]_ -----Foundation __ __� Property Line .__.______ <br /> S -- -e <br /> SEEPAGE P,T E ] Depth_�!-'.__ _-Diameter---------------------Number K Rock Filled ' Yes'[] No ❑ <br /> Water Table-Depth-----------------= = ------------'----.Roc Size------------ ---------------------------- ------ <br /> Distance to nearest: Well__---------------_--------------------- ------Foundation--------_ -----------_._..Prop• <br /> „ Line__--------------_------ <br /> -- Date . =REPAIR/A[ ITION (Prev. SanitaI ion Permit#-------- -- ---------------------- -- <br /> .i <br /> Septic Tank(Specify Requirements)--- <br />