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kFbR OFFICE USE: ?r -- 'APPLiCAnoN FOR SANITATION PERMIT i Permit No: . '-------- 1i - ------ ---- (Complete in Triplicatel . " Date issued This Permit Expires 1 Year From Date Issued ealth l the work herein I A gibed.This herebyapplicationdeito the San compliance l H Countyt0 d'marn a No. 549 and existing Rules and Regulations: rmit to construct and ln s-0 J"Os / / p __. 306 ADDRESS/LOCATION _V Y�✓� 5� - -�Y_@ISF�U-�nj-' --- -" CENSUS phone qq�� Owners Name _-Fi--d.-- A..�-�'..__�..3G. _ Y- ------ -------------------- - .Cry - - p / Address --- s - -�--J----�-�--�' - . .. Phone �J-__. i. _ a_.License# ------:-:---------- Contractor' --------- Contractor s Name .._ _ Re Installation will serve: Residence($t Partmeit House❑ Commercial[]Trailer Court ❑ Motel ❑Other � Q - 2,...._Garbage Grinder __�. Lot Size ._.. _--- Number of living units:._- ---. Number of bedrooms a Private❑ Water Supply: Public System and name ---------- ---- -1—'-J. -•Z--"P---'-- -----'- -" "- - Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Cloy ❑ Peat❑ Scndy Loam ❑ Ciay Loam A' . Hardpan❑ Adobe ' Fill Materia!----........if yes,type------------"" I _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on %e� side.) NEW INSTALLATION. (No septic tank or seepage pit permitted if public selw/er is avoi�tayble within 200 feet.- SEpTICTANK Size..,(�----- f '/' Liquid Depth PACKAGE TREATMEM { 7 - k \ Compartments ---�..•----•-`-- . Capacity _f_�Qfl------. Type - r2 4' Material. �- - / ttFoundation - ----------- Prop.tine_. - Distance to nearest: Wel! ._1_.��.�� ,�--- • ____._fi.._ Length of eodm line -..._ C��--- Total Length --- • LEACHING LINE No. of Lines -- pt Filter Material ___ -•--••• - ._. gym' • y 'D' Box --- Type Filter Material, ,-- .... O j property L'n .._. -- ..... - Distance to hearrest- Weil -_/..!? ._�'-----Fovndation .. _-_--- ----------- ISEEPAGE PIT Depth 52SI------ Di meter ti�_ -Number ----- _ /_---------- Rod. Filled Yes z_ No Q Water Table Depth --.PPn^ ------- ........ Rock Size _. _ >4_ ..-------- "`-o" -- t > Q�--. Prop. Line .�-------- i -.--...,_.._Foundation _.... -- Distance to nearest:Well .._._..�. -.--------- REPAIR/ADDITION(Prey. Sanitation Permit# '------•---------------------- -- Date ---------------------- ) Septic Tank (Specify Requirements) ----------------..---....--------------------- f Disposal Field (Specify Requirements) ----------- ----- '-- ----- '- ----------------------- V ------ ---1------------ - red addition on a A (Draw existing and requireverse side) ` will be dens-in accordance with San Joaquin I hereby certify that I have prepared this application and that the work . County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hearth District.Home owner or licen- sed agents signature certifies the followingsis such manner "I certify that in the performance of the work for which this Permit is issued, l shall not employ�Y � t as to subject Camp am ation laws of Cotifemia-" _. ✓Clwner Sig -' -- - Title If other th owne FOR EPARTMENT USE NLY/ pp --- DATE -� ..... 7-------- APPLICATION ACCEPTED BY. +e-- ------ -- -- - BUILDING PERMIT ISSUED ------------- - ----------•-------------DATE .--------•----------------------•- ADDITIONAL COMMENTS,----� -- - " • - — - - ------------- ----------------------'----------------- ------ -------------...................... " — -------;_ - -------- - ---- - -- -' - -- - ...................Date ... .0 Final Inspection by- ------------�- -._..- - -- ---'------'--------'- SAN J AQUIN LOCAL HEALTH DISTRICT E.H. 9 1-'68 Rev. 5M