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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..................................... . .. Permit No. _.7.�.:._.._-.••- •�• ....... . ------- . (Complete in Triplicate -- ------•-.-----, --------------------• Date Issued -�--•5 ..�5 ...................... This Permit Expires 1 Year From Date Issued and instail the work ApplicationTis his application e e mothe m de in compliance with hin Local �Coulth ntytrict foOrdinance permit m549 and existing Rules and Regulationsrein described. Z a CENSUS TRACT q -070 Dl L�ATI .__.-..._ z � _ JOB ADDRESS/ .... ..Phone ............... ............•-» Owner's Name + ....... --•-._.........�..._.._._»._...» .. . .. - 1r------------ ------- ------------city Address �- ....... ... ..... — Phone ............ ...��... d i ' _ ..-License# - - --- Controctor's Nome -._ - -•- ' • Installation will serve= Residence Apartment House❑ Commerc�ler Court Motel❑Other ..... .. ..... . Garbage Grinder .__..._...._ Lot Size .�-____.....Private 0 Number of living units ---- Number of bedrooms --•••• ,,,,_Private❑ Water Supply: Public System and name .................._. -_. Peat Sandy Loam 0 Clay Loam 0 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ❑ Hardpan Q Adobe 0 Fill Material ....__...If yes.type•-•-.._._..�.-. ti size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side-) � (Plot plan, showing NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 206 feet,) ---___. Liquid Depth -••Mw PACKAGE TREATMENT ( I SEPTIC TANK 11 .. ». No. Compartment: ._..... »... Capacity Type --•------•----•-' _- Material....... .�............... _Foundation ........._-------- --- Prop. Line Distance M nearest: We ..._..»... ._..._'S ll '_-"..............._�..._-._... g line---------------- ------ Total Length ------..._.....__...._.»S No. of Lines ........................ Length of each LEACHING LINE l -------- *D* Type Filter Material ....................De Depth plhr Material ---------- --------------_..� � 'D' Box _.......---- party Line ------------------IPF ...... foundation _.._....--------------- Pro Distance to nearest: Well ...........- Rock Filled Yes ❑ No O SEEPAGE PIT ( 1 Depth _..»............ . Diameter .._.-.�_____ Number ......._...... .. --------- ......._........ Water Table Depth ................................_.. ..Rock clatii Sk= -.-- -- ...... Prop. Line ..._....._�....._. on Distance to neorestc Well ............................... ...._ Oois---- .�..__.... ...._) REPAIR/ADDITION(� Sanityion Permit# _-.�___.--•-•-•............................ .�................ Septic Tank (Specify Requirements) ......... "»r` - �....»::.._._. �.•-.� � Q .. .. - • virem ts) •••••. x s - Disposal Field ( ecity Req L_.cs _... ............ -- •--.................. .._ ...._.. _' ---.. ...... ............. ........................... with Son �oai4vin ••-•--•••••• (prow existing and required addition on reverse side) in accordance _.» pared this application and that the work wlbedo" " In District• Nerve awn" or Ilcen- 1 hereby certify that i have prep County Ordinances, State Laws, and Rules and Resulations of the San JoaquinM such maener sed agents signature certifies the following: ermit is issued, I sholl net employ any persue W certify that In the perfarmanee of the work for which this California." w Werk a Cempensotien laws of Ca as to become sub _ Owner Signed .................. ....... .�_.. Title . � 8-�1. ....._....-.........._..._ .� ... •- wner) (If other than T iiSE ONLY FOR DEPARTMEN OATS ----- ....:Z... ......... ....................................... DATE APPLICATION ACCEPTED BY ................................. - .._.._. _^. _ ......._ _ _...._........._».....••-•--.._____.-......._ BUILDING PERMIT ISSUED ---------- ..... ..........». ............». _�»...........�....-_-•---•--_ - »---------- ADDITIONALCOMMENTS ...._._...-•-••".....____.---._...._._-..._:_._...... ...._......---».......... ....... ............. _......_.._ _.. ........... ................ ...........................:• .............................. ....... ..... ..... ....__....---••............_•. -•---- ..... .----»» __.Oats' - .. ...............•-- \r Flnol inspection by. ...:..... .. ............•-- .. - ..»».. .__•. SAN JOAQUIN LOCAL HEALTH DISTRICT 7/72 3 A E.H.L3 241-'68 Rev. SM