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L_�'j OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --7 - � (Complete in Triplicate) Date issued PThis PermitEx fres 1 Year From Date issuework -------- ermit to construct and instal! the ulatonsrejn Rules and Regulations- to eg is made in compliance with County Ordinance No. 549 and existing Application is hereby made to the San Joaquin Local Health District °rap S TRACT -------'" Iicatio n CENSUS -- described. This app �igsu__auf�..- ------- -- - }OB ADDRESS/LOCATION - ---- ---------- �•-------- ----------Phone ----------------------- --------------------- --------•----. .� e�r ---------- -------- --- ------------- --_ Cit Owner's Name ----- Y --•------ �,� _ AL/��U---- ------=--------------- "" Phone -------------------•- Address --------- --- � --- - i License # ------- ---------------- ---------------------- .----------- l�a� --------------------- A artment House❑ Commercial❑Trailer Court .❑ Contractor's Name -"------. Residence� p in will serve: v �} Motel❑Other .--------------------------------------- I. J Garbage Grinder {"+°5__-- Lot Size - Private [❑ Number of living units:"."- .------ Number�b bedrooms Grinder �o� -------------------------- --- ---------------•Sandy ------------- Water Supply: Public System and name Silt❑ Clay ❑ Peat❑ Loam ❑ Clay Loam :❑ of 3 feet: Sand'[3 - Character of soil to a depth � gdobe'� Fill Material ------------ if Yes,type ------------- Hardpan ❑ buildings, etc. must be placed on reverse side.] in relation to wells, / Y (plot, plan, showing size of lot, vocation of systemit permitted if public sewer is available within 200 feet,) No septic tank or seepage p p Liquid Depth ------- NEW INSTALLATION: lF Size------/420 ------------------ compartments -----�'--- •--••--- SEPTIC TANK'[ 0 hie_ PACKAGE TREATMENT [ 1 t Material Type "Lm- /-- V Prop. Line - �d Capacity "w? t --Foundation ---� -------- Distance to nearest: Well h__ --" ---.------ Total Length .-------•-------•---•------- r - --- Length of each line -------------------------- -- --- ------ - - - - --•--------•------------� No. of Lines ------- ------ - LEACHING LINE [ ] _Depth Filter Material ------ --- Type Filter Material "---- --------- --- -- 'D' Box ----------- Yp Property Line. ---------'-------- t _ D"+stance to near ��X 90 �-'e CiP--:- Foundation -- Rock Filled Yes NO ] N p - Number --------- t 7 -- -��------•-------=-------Rock Size -------------------------------- SEEPAGE Water Table Depth ----------- - Prop. Line --- ------------------ I --•-------- ___Foundation Distance to nearest: Wel -- --- ----- _ ______""_"] i ------ Date ---------------------------------- (Prey. Sanitatwn er ------------------------------------- ------------ Septic Tank (Specify { ------- ---------;----------------------------------------- ecif Requirements) -----�-- -------------------------•--- ---------------------- ecif Requirements] ------------- --------------------------- Disposal Field (Specify ----------- "-" - - ------------ ------------ ---------------- -- --- ---- --- - I (prow existing and required addition on reverse side) this application and that the work `"ruin Local ll be oHealth D'strctnHomettowne in OccOr ner or liven' 1 hereby certify that l have preparedulations of the San ,leap Ordinances, State Laws, and Rules and Reg County person in such manner sed agents signature certifies the following: permit is issued, 1 shall not employ any "I certify that in the performance of the work for which this as to become subject to W01 owner ompensation laws of California." - ---------- Signed - "� n , __ ------------ - Title --- ---- �-- --- I � -- IN-1#ei ---- ---- ----- BY --------- -- Q _ -- (If other than owner] Y FOR DEPARTMENT USE � - DATE 7"-�" ' ---- --- -- -------- - - DATE _..-- --------------- -------- -------•---- APPLlCAT10N ACCEPTED B ---� ---- --- --� ---- ------- -- - ---------- -------- -•----------- =---------------- BUILDING PERMIT ISSUED --------------------------------------- _ _ _"-- --•-------------------- - -------- ADDITIONAL COMMENTS ---------------------------------------------------• ----- = -------------------------------------- ----- - --- ----------------------------------------- ----------------------- --------------------- ----------- --_-W � ----------- ---- Date _ Final Inspection by: --------------------------- ISTRICT SAN JOAQU11v LOCAL HEAL � ro 1 ,AQ Rav 5M