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FOR OFFICE USE: ------------ ------------ ------ --------------- APPLICATION FOVSANITATION PERMIT `-- "-(torrip`lete�n Triplicate} Permit Na. pp----- --------------------------- -- __��=_3-a•:- 7� - - - - ' is Permit Expires.i Year From;Datelssu-� _jDate Issued Application is hereby made to the San Joaquin Local HealthYDistrict for apermit described. This application is made in compliance with County Ordinance No. 5490and ex stingconstructnRulestalndt he Regwork ulat onsrein JOB ADDRESS/LOCATION _ _ ��^`,^� ------ --_--CENSUS TRACT Owner's Name ------ - L.,-' d - '-} ------------------ = - Phone Address ---------4_13011;; cit tFSCA1-0 N/ ontractor's Name _ ��AG�, v - -------------License # --- -----;----- --- - - - ----- Phone ------ ----------------------- Installation will serve: Residence... _..partment_House[] Commeircial [Trailer Court i[] -Motel ❑ Other ------i --__-- n' Number of living units:.___ ------LNumEjer of bedrooms —_Garbage Gr.inder "N�_ Lot Size --__-17- lir i . ater 5u I Public System and name ------------------ rn-- w,.;. -_ �' -------------------------------------- ----------Privateer _. P Y� C aracter of soil to a 1 ! depth of 3 feet: Sand'� ^ CI . _•`- -.. Sand # Y (]' .Peat�'�r y Loam Ciay Loam-E] Hardpan P Adobe '[] Fill Material �--- If yes,type ---------------------- �-� r-. ----- (Plot plan, showing size of lot,'locati n of syster i_in relation to wells, buildings, tc• must be placed on reverse side.) NEW INSTALLATION: (No septic tank or see a e"p :r t P 9� P•it permitted if public sewer is a ailable within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC T' l l Size ---•-r="}-------- ----------- Liquid Depth Capacity ---- T ! Yp.,� '------------ Material- --.- N p �-------- --- o. Compartments Distance to h e rest: Well i ='''� ---_........ _____ .---------------------------Foundation ----- - tProp. Line - LEACHING LIN!"`��, -., - - ___ --� [ ] No. of Lines --- ---------------- Length of each line.__,'-------- -_-- --------- Total Length ----- ----------------- 'D'".� Box .__------"' Type Filter M—{aerial ____________________Depth Filt Material - f 4- Distance to nea est: Well ____-____---_-_-_--__- Foundation ---------- - ` SEEPAGE PIT [ ? Depth #- ------------ Property Line -------------- Diameter --- Rock Filled Yes 0 No ,� - . �„ - -------- ----- Number --= ------ - --- - -- able De th _.. Distance --------------------------------------------- Rock Size- Distance ize --,--- } Water I to near st: Well ____._-_--- REPAIR ADDITION Prev. Sanitati f L v Prop. Line --- - on Per # • -------- Date '-- `__} Septic Tank (Specify Requirements] --__ -------------------------------------------- ------------------ Disposal Field (Specify Requirements) ----P/�� -- - F 4 --- - `aC_ X 1 -- C _ _... , (Draw existing and required addition on reverse side) --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coghfy Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: cen- "I certify tin th perfor a of the rk for which this permit is issued I shall not employ an as to.bec a subj to W rkm p Y r person in such manner tion laws of California." Signed,_ B • - -- ------- ---- ------- caner By (If other than owner) ----------- ,Title -- F -- --- ------------------------- FOR DEPARTMENT USE ONLY r ; _ APPLICATION ACCEPTED BY__ -_+-R - 1 /� _ t BUILDING PERMIT ISSUED ------------------- --- DATE -----,7 _--/_ �.��_ s ADDITIONAL COMMENTS _- - ----DATE --------- ---------- ----------- ------ ---- -- -- --------------- - - -------------------- ---- - -- -Final fnspectio _ - - -- ----- - - - - - - . -- ------------- ---- _-. ._- • -- --- --- --- - - -Date_ _. i • -- : . SAN JOAQUIN LOC ALYrFiEALTH ,DIST,RIC7 f , , E.H. 9 1-'68 Rev. 5M _