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--FOR OFFICE USE: " APPLICATION FOR SANITATION PERMIT Permit No _ .... ............ ....... ..... } , iCo4ietel'n Triplicate) Date Issued .. _. "... . .. . ' This Permit Exp{res 1 ear From baro issued , ............. ...... ............... -- A Application is hereby made to,the-Sam oaqu n eaith-District-for""a-'prn'mitlto construct and install tha work herein Pp co ce with County Ordinance No. 549 and existing Rules and Regulations:' .described. This appIi atiy�on is maR f J C:ch ..".....................'"CENSUS..TRACT .......................... JOB ADDRESS/LOCATION �: Phone ....."...............•--••-..... Ir Owner's Name _-... ., .. ....."......1 - - ..;. ...... .... ... .. Address :. .. :..... �..�,-.� nse Phone � Lice � c��-jr-'1.1..,/ Contractor's Name _ �• Residences-Apartment Hou :Installation Court 9 ' Installation will serve: 1 �� , . . Motel ❑Oth " •----- �' er i ! ! `'9--� Lot Size --- � .............. i ' ,�... Number. of,bedrooms .....Gdrbage Grinder _".: + 10'. Number of livisag units:_.__- .- A. ....Private i to ❑ Water Supply: Public S sterrrwand name.= .. Clay Loam 0 ` � � Silt❑ Clay [] Peat❑ 'Sandy loam �Q , v Character of soil to a depth of-3 feet:�,Sand n _ n Fill Material .. ... if yes,type ..... •* Hardpan ❑ Adobe� ----••- . . (Piot plan, showing size of lot,dcatiOR of system in relation to wells, is ii}dings, etc. must be placed on reverse aide.) it permitted if public..set+veris avaIt ilable within 200 feet,} ! NEW INSTALLATION: �(No-septi� tAank or seepage p p /, ..,� # F , Size.. ,6ff---./0.._• E Liquid Depth _. .._.... PACKAGE TREATMENT ( I SEPTIC TANK ' ,i ; O0 4 YP ��aterial Na. Compartments _ .............. T e . Capacity •-- . �s��t_�•�.:. foundation . •-----•--- r •-----.... Distance to near6st: We1I',_,_ .�.(f:_ Pop. tine � 6 - r - I ..... .. } a �.`'•"-".""'Length o ach"�iine.'`i eO...... f Tot Length - Nb.—oof"Ciffe :../• --- LEACHING LINE . ......y...�:............... pe #h filter Mat, Filter Material / lX P � 'D' Sax ..�"... Type > 1 aunciation .../8- ---3•/7 Property Line ._ .. Distance to nearest: Well . � '� Diameter -�. `-� ............ ''Rock Filled Yes Na Depth s •� .. Number . .... SEEPAGE PIT � r= . ...._ Rock Site y ---•- Water Table De ---....: .............Pr . Line,: Distane to neatest: Well •--- 5Date • } REPAIR/ADDITION'(Pt v:rSanitation Permit'# -•-•-••-"---•-••................ :.......... + •'.........................................:.. •--- Septic Tank.{Specify Requirements) •----•.... ............................. r ecif t Requirements) ---•--•-•••-. ----- ----- --------------- :.. Disposal Field (SP Y ............. ..... •--•• .............•-...............------------ •--........----------... s .............. ....."".._._- ----- ( ------------------ ------------ ; •• with San Joaquin Draw existing-and-required addition on reverse side} 1 hereby certify that i l�pve Prare �saPPllon andtfEest,�tl±e�wor_k: ill.:he done In accordance County Ordinances, State Laws, anti Rules and Regulations of the San Joaquin Local Health Dbtrict. Herne owner or llce+t- sed agents signature certifies the following: r to arty person iiiJuch manner "1 certify that in the perforn+ance of the work for which this permit.IS issued, I shall not employ a as to become subject to Workman's Cornpensatian.lawa of California." 1 , owner r Signed . ................._ Y --- . .. By ..-. title .. -4� (If other than.awner} 1. r E r EPARTMENT USE ONLY ( i 1 DATE . -- !`7 -------......- APPLICATION ACCEPTED BY.'.'�.' -------• - "D�i TE BUILDING PERMIT ISSUED " -- --- ". ...-••.........-----. ......................'............. ....... ... ADDITIONAL COMMENTS__:" x _....._.. .".....".::. .�. - ............ _...... ."."" ; ".".._". � � .................Date .y final-IrrspecNon~by:`---------- Ell 13 2!r 1=&� JO UIN LOCAL HEALTH DISTINCT'#Y 8/7h 3M s