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FOR OFFICE USE: r -------- APPLICATION FOIL SANITATION P IT _ _ ! In Tripp_c (Complete _ atolTi. _ Per t No 7 a .......................`........--.I.•••........... . _ This Perati;Ex•Expires 3 Year Fret",. ., . ,_..�._...._ Date Issued .. ..... .- P Dot*Issued Application is hereby made to the San Joaquin local Health District for a permit to consttuet and install the work herein ` described.This application is made in compliance with County Ordinance No. 549 and xlstin Rules nd Regulatlons:'T JO. � e oht' B ADISRfSS/LOCATION ....�,yf P •e+... 7f.,fitp. �.. ...l.�4I)[ L°`�j.....,.....CEN CT�..... 2d Owner's Name ... ., ° .-.�'... Address ... ........... ._ � �r��................ .,. ....... ...t. .................Phane �'.' . �/ .,City .. ?. ..........._ ............. . Contractor's Name ....-,.z% .�.itt.� Cs �e + a. Licen '�� . ...� ..,.. ..... .......... ae ils '�� ... Phone 6 G O Installation will serve- `, -,jt Residence 04 Apartment Housafl Commercial QTrailer Court [3 , Motel❑Other............................................ Number of living units: 'N _.... -•--- umber of bedrooms .......Garbage Grinder ............ Let Size Water Supply, Public System-and_nome ••••._ ...... .............................................. ..Private y.. Character of soil to a depth of 3 feat: ' Sand El. Silt[3 Clay .[3 Peat❑ 5andy Loam[] pay Loom ZZ; � l P Hardpan 0 T Adobe� FIII Material n ,�.. .. . ............ If Yes,type............... ............ ; - (Plot plant, showing site of•VdtAd a�ayon of system in relation to wells,=buildings, etc, moat be placed on revere' side'.) NEW INSTALLATION: " ;No septic ton-k or seepage pit permitted if public sewer ls'available within 200 feet,i g 1 PACKAGE TREATMENT'�•f�] SEPTIC-TANK{] -' Size........:............ f ,�Liqutd.Depth � Capaaty Type -------------- Material.... ..- ... ...._-_.... Nb..,.Compartments .. r • ......................Oce Distance.to nearest, Well. .........................Foundation ...... Pro Line E LEACHING LINE f I .. No, of Lines ........................ length ofeach fine.........._._.....::_.__.. .Total Len th DBox .__...:.. . Type Filter.faterialr .:L ...........Depth Filter Material. Distance to nearest: Weil •.....:.: SEEPAGE PST Foundation ........:......._.._•..,. Propenty Line .....................:.. .` f Depth .....:::........._.. DiQmeter Vumber ............ :. ........... Rock Filled Yes No 0 . t Water Table Depth ..........-•............... ...... ..... ..Rock Size ........... Distance to.nearest: Well ......:....... .Foundation Prop. Line . 1 R6PAiR/AdpiTION#Prov. Sanitation Permit .................... Date . .......-•----........ .............. i 0'. Septic Tank {Specify Requirements) ........(161:c),X .._ .............. D poral Field ISpetify � equiremeritsl .. .. .._....._.......j.........' ....... .............:... � -•....... ... ..........:.....................! .. . ....r...... Y -- andrequiredadditiononreverse.....ido....l..........................__._..................._......... Draw existing : I otere6y certify thc Cot J have Prepared this application ant! that"chs work wiil he done In accordance wftlt•Son via unty Ordinances, State Laws, and Rules and Regulations of the San Joaquin total Health �ettg :Distriit. Home owner or Ileen. sed agents signature certifies the following: "I certify that In the perkprmance of the work far which this permit is issued, l shall not stnplor any person in such manner as to beco subject to orkman's Ceenpan tipn laws California." { Signed _. ._..----• .._ ........ .........:...... OWnet• M g -------- .... � By :...... -...._.. :.....:............. Title,._ Ilf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTBY ....... . .. ....... . . ' BUILDING PERMIT ISSUED _..:.".`_._._.: ..._._.�..z, c__:.......__.._...... DATE .._.- .:.�� ..7_.�_.........� _�._ _ .. .. ATE . ... , .. ADDITIONAL COMMENTS .• . ...................•---•.-......._• _F: ........................ . ------- ....----- - .............................. :.:... - Finalins - ..........................•--•---•-...............-_... ....._....... 13 2 �-bl3 tiev, Date .. '... ` ,/ ....... .....: SAN �OAQLIIN tOCAI HEAf.TH DISTRICT---....._. 8/7h 3M .