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M - FoR'OFFICE USE: APPLICATION FOR SANITATION pjEttMlT � 70 Permit No. -------` ------------ -- ,• (Complete in Triplicate) ----------------- ------ -- Date Issued -_�--��-`-•• -- ---------------- --- .. This Permit Expires 1 Year From Date issued, d F�4-'T� 4�/ # Application is hereby made to the San JoaquinLocal ecwitfh Countyt0 ordinance No549 and er sting Rulesnd talnd Re tions..l the work described. This application 's made in comp) w1 C NSUS TRACT ---------------------•---- K JOB ADDRESS/LOCAT 5i .5 =- �FFf �5 - p if- - Cif` T T --Phone c�- _s Owner's Name " ' City -IV_!/ite-�"------------------------------•-••-------- L --------------- Address �T----` ----0207,-- --- y �3/ ---�.5�� License #,4_y:�-q`�J -- Phone Contractor's Name -_.�� -- ----x------ - -Residence ----- Residartment House'❑ Commercial:❑Trailer Court Installation will serve: p Motel ❑Other _- --- � " i Garbage Grinder _--_----_--- Lot Size _3--- - --- Private- Number of living units_____________ Number of bedrooms _-__--__---- Peat❑ Sandy Loam Water Supply: Public System and name -------------------- --=----- - -_-- ❑ Clay Loom Q Character of soil to a depth of 3 feet: Scind' silt❑ ClaFil�atenat__ l3-- If yes,type k ------- Adobe.� e _ - ., Hardpan ❑ -M — - etc. must be placed on reverse side.] (plot plan, showing size of lot, location of system in relation to wells, buildings, \ NEW INSTALLATION: (No septic tank or seep ge pit permitted '9f public sewer is available within 200 feet) th Size-t------- x! _-X- ._- ---- - Liquid bepth _-�_.- ----.----- PACKAGE TREATMENT [ ] SEPTIC TANK _ • C�E'rll��_-_- Na. Compartments -----�•-•----•--� p ®- � TYpe�K-A'13--- Material' } Capac�ty.��-- ---- -10-- Prop.Pro Line ®- istance to nearest: Wel! -----------------------_ ---Foundation -___.___.�_-_ _ - P• �- _ Length of each line--------------- Total LenID gth r-�_--- ------ LEACHING LINE No. of Lines __________________ (� E D' Box ��- Type Filter Materials+ C-�-Depth Filter Material ------ --------•---�--- i Distance to nearest: Well -------,----�-�-- Foundation ---------------10-- Property Line ------------•-----•-•--- Diameter Number ---------------- Rock Filled Yes ❑ No ❑ SEEPAGE PIT [ ] Depth ----------- ------ Water Table Depth -------Rock Size -------------------------------- Distance to nearest: Well ---------------------- __ Foundation -------------------- Prop. Line --_---------------- EDate ------------------- -----1 REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------- _ Septic Tank (Specify Requirements) -_�------ - Disposal Field (Specify Requirements] -- - ---.�--"--f -� �- -- ----------------------------------------------------------------------------------------- --- i -- - _.. , {Draw existing and-requited add.ition_on.reverse si. e� _ _ — - I hereby certify that I have prepared this application.and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. }Lome owner or licen- sed agents signature certifies the following: for which this permit is issued, I shall not employ any person in such manner "! certify that in the performance of the work as to beco ubj to W man's Compe ation laws of California." Owner Signed - --- --- -- ----------------------- ---------------- Title ----- ---------------- - ----------- Y ------ (if other than owner) FOR PARTMENT USE ONLY APPLICATION ACCEPTED BY r" 4®------------------------ - - DATE - -- DATE --- --------------- --------------- ----- BUILDING PERMIT VSSUED -------- - ADDITIONAL COMMENTS ------�� Il� ------- - - ------------ ------ ----------------- -Date --------- ----- --- - --------------------------------- Final_l�pec#ion bY: --- -- _ � --- ---- -----64�� SAN JOA QUIN LOCAL HEALTH DISTRICT F N_ 9 1-'6B Rev. 5M _..