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FOP OFFICE USE: APPLICATION FOR SANlTATlON PERMIT / Permit No _71-1_11Y ------ ----=-- -------------------------- (Complete in Triplicate) _ ------ --------------------------- Date Issued - This Permit Expires 1 Year From batelssued l the work Application is hereby made to the San Joaquin Local Health District i for n a ermit t and ez sting Rulesnstruct and talnd Regulat ons eir e is plication is made r irk,compliance with County O d ' — SIDS TRACT _ �, ----L+�-� �_N�_�.,� -------- -----`: ---,-:_CEN r ---------=-------------------------- _.-r's L.d --�D13�� ----- ��S - --- --- - ---------- --- Owner's,�i.ame --- --- - --- -�- �� - � --- - Phone f � -- - - --- -- ------------------•------------ _ - _ I ------------ ------------City ---- Address SCS}LQ 1� -e __A artment-House,Q £gmmercial :❑Trailer C Phone ---------------- Contractor's Name .__Q - ----- License # ------------ � -- � - Court ,❑ will-serve!--�--�""•t Resident ❑ p ! ` Installation } Mote1 ❑ Other.--------------------- ---------- 710 -__"_-- __ f - -------------------------- ---- - s 7 1 r _Garbage Grinder -. -- Number of,living units:.- __.___;-- Number of bedrooms-_ , - � - �� Private Water Supply: Public System and name -t �___��____ = - --------- Character of soil.to a depth of;3 feet: Sand'[I-P'/ t Clay ❑ Peat❑ Sandy Loam {Clay Lvam ❑ 1 .�-s-�== --- ardpan-E�` -.Adobe-0-�Fili-Materials- : ---1f yes,.type _, [ r ' (Plot plan, showing size of lot, [location ofsystemin relation to wells,,buildings, etc. must be placed on reverse side.) j NEW INSTALLATION: (No septic tink�or eepa it permitted if public sewer-is-available-wa#hiri 200 feet,} Size i PACKAGE TREATMENT [ j SEPTIC TANK 1YfQ 'Y,� Liquid Depth __. z5_-_-"-----. . 117— Type o. Compartments _-- - _ r J -• - - _ Foun¢ation(''__AV----�-- Prop. Line ____.-----"�--- stance to nearest: Well ------ - ------ r ; LEACHING LINE ( No. of Lines -----� --------- Length of each line ---- ---------- Total Length :<</60------------ G 5 Type Filter Material �-G -- Depth Filter,"materiai _--""__1_�------ --•- -------- t 'D' Box/ i - i [ a tion - ^ Distance to nearest: Well -.-" dFounda ' SEEPAGE P!T [ } Depth -------------------- Diameter ---------------- Number -------------i_{----------- Rock Filled Yes [I Note] i ---------------- --Rock ' el1 Foundat o ' ----_�-- -- Prop. Line e Water Table Depth Distance to nearest: W Date -------_IE�--------•------) ItEPAIRfADDITION(Prev.. Sanitation Permit#.-------- .1. ti '_ Septic Tank (Specify Requirements) --- --- -- ------ ---- -- ---- •-------- ----- IV ---_ -._ --� I+v..'�4 ~._.� �...;••.�:i`e� +w.�.�""`mn!}aa=� Disposal Field (Specify Requirements) - = -------- --- --- , lcC -------------'-_ ---------- ---- r. l'� � -- ----- = �' ---------------- ---------- ,; ---"- f — � L ex,`s#Ing and required addition on reverse sed r # application and that the work will be-done -�n 'accordance-with San Joaquin I hereby certify thptyl have prepared this app County Ordinances, State Laws, and Rules and Regulations of'the San Joaquin. Local_Health District. Ho e,owner or liven- k. sed agents signature certifies the following: JJJJ I ..k ��, "I certify a ijherF*'tma ce of the work fo which this permit is issued, 1 shallnotemploy any personin such manner as to be e s 's Co ensa on laws of California." ' _ _ Signed -------------- Owner B - --------------- ---------------- Y _-- .... (If other than owner) ' � 4 FOR DEPARTMENT USE ONLY �w ``�'�' ------- ..;- ----------------- --------. DATE ------/� -- APPLICATION ACCEPTED BY ---------------1-.) t BUILDING--P€RMIT:ISSUED ------------------ --- ADDiTIONAL COMMENTS ------- E ,r = _ % _. ------ ----- - --- - ------------------------ -- -- -- - ------- - ------------------------------ ------------------------- --- -------- ate ---- - --------------- ----------- --- ate ------------------ ----- ---------------- - --- Final Inspection y: .--_ --------------- - , A -.. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 ; 1R 68 Rev. 5M