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coo L � . FOR OFFICE USE. FOR OFFICE USE: APPL1CA'itiEON FOR 5ANITATEON PERMIT Permit No.,-,15,- ICpleDa in Triplicate) r Date Issued �.�/ RYear From Date Issued _ °� � .�.........W---•-- This F°anssit L:stplrats ,.:. _-- _---- Application is hereby mode to She Son Joaquin Local Health Disitict for a permit to construct and ins the Work herein described. ' This apiplicat;or: is mode In compliance with County Ordinance No.544 and existing Rules and Regulations: r pCENSUS TRACT . •..... . ... �. .Ii !OB AI DRESS/LOCA ION I_ .7.. •.�-......C..." .. n.A ...J"�1....,. ... Ownerlls Na .r...... .............. ..... ............................... . .. City O .'.. Phce Address....:. � `•. o w Contraz'tor's Nam 6t 4L _ . ...........License . . .5�7.�.....Phone. K � lnsta latf on will terve: Residence J;,-Apartment House ❑ Commercial ❑ Trailer Court ❑ r. k Motel ❑ Other.., ....... ............. .......... ._... Q... �......... .. ... .... t r Number of living units:_.,. ,�:....,.Number of bedroom.s. .3...-.Garbage Grinder_.. .......Lot S;Ze.......,. l.. r . .Prrvat wwer liupply: Public Syslwn and name.............. . ....... ..... ... ..._...: . ' e{ .f i"hartrtter of soil to a depift of 3 feet: Sand ElSilt[3 Cloy r, Peat❑ Sandy Loam ❑ Clay Loo Hordpan,❑ Adobe❑ Fill Moterial. .. . .If yes.type .. . ............. ... ..,.. `t $j IPIo! ipan, bhowir q sura of )at, location of system in relation to wells,-buildings,etc. mvst be plated on reviwse side.)N'er is available within 20i) Feet,) M NSIALvLAT`$tC N: (No septic tank or seepage pit permitted if public se W PACK AGC YPEATMENT I ) SEPTIC TANK I-I- Size ..�..� . X-...� .Z:l Liquid Depth ... ......-�,I 6. f Matoriol 1A. ...No. CompartmentCapacity. G ......Type ... -.2—_s ... ... a� Distance to nearest:Wei(,. .... ... .�.r.......................Foundation ....�.�.r x' ... Prop. Lino baa..'........ ,. fLEA C" i' No. of lines............. .. .. .Longth of each line., .............. . . .. .... ._.......To Length _ f!Z�.... .......... h ° tel le D' Borg: ,`Pp..Type Filter Moterial. . '� e.-. Depth Filter Mater4al....._.. . r i f �I �j ..... . - D,itance�to ntiarest:Well:.... .'2 J�-.... ......Foundat;on...,2?'j_' ._......:..Property Line. .`+.+ w� SEEPAGE PIT ��- Depth.a?a.+..Diameter._.. ��.J}.....Number.......5.. .................. Rock Filled Yeses- No❑ . Sw Water Table Depth......./f0........................ ...... •......Rock Size... .. . ... ... ....�� .......... ,... Sd D Distance to nearest:Well.:...C.. � ....., '........... .._Foundation .... ' ..��. ......,., Prop. Line +�.... ..... ... REPAIR/ADDITION IPrev.Sanitation Permit#.... Data } ... Septic Tank S sci R uirements} : P fY ts) pis...sal Field ISpetify Roqulramo .. . . . ... ... ... .. . . ... ..- IDraw existing and required addition on reverse side) I hereby CgMfy than I ho.a prepamd this application and that the work will be done In accordance with San Joaquin County Ordisioncei, State Laws, and Rules and Itepulntions of,the, Son Joslquin local Health Dis"ict, Home owner or licensed agents slant tvro cer410e1 the foLlowingr t "L e.ntify oral Lit the porformanco of the work Pa+ which this permit is issund, I shall no employ any parson in such an as 'o Estcnenu su to We en's Cnmpensal3an laws of California."3€gned .,. .. -. . .. •. .Owner /� � ._ �i�`� r�✓� L.o Ejv ...�. ..., �... ..... _ .. Title. Q/Cl�/fL.• C (If o ar than ownerl x i FOR DEPARTMENT USI= ONLY DATE APPLICATION ACCEPTED BY, p DIVISION OF LAND NUMBER DATE ADDITIONAL COMMENTS irtnl Iroshvctlnn hy; � M.t / 7176 3fA t,+ 19 r•a 3StAN .v;�I�QUiN if`s',:L H3=ALTl-€ D4STR€CT I f;