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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..'��_33f/ ---- ---` ^..-..... ... (Complete in Triplicate) I r� V ................................ Date Issued ....._............. [- . -- --- ---......... .. ................._........ ThisPermitExpires T Year From Dale Issued , Application is'hireby'made to the' San Joaquin Local Health District for a permit to construct and Install the work herein I described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Reeg^ulations: / 14 .! CENSUS TRACT _J._.. 109 ADDRESS/LOCATIONL., {IJ�Y="''- '.-1 J:W ----/ ................................. Owner's Name -------/14A. -----s--/..�..KAS--� ..............:.................:.....................Phone — Address W _.1.._ Q ...........city ....... . . .R ...TE:. .......�� - -��. ....� /...... Contractor's Name .Q.LLt a.Z.(.. ... ......... ......`........License # ..._....:------------- Phone h Installation will serve: ` Residence artmentousel] Commercial[�Trailet Court '❑ t1i QAC Maid ❑Other .: /.._... -. . . . tto�'f ............ \ F Number of living units:"..... ..... Number of �e rooms,. Garbage Grinder _.... Lot Size . ._... �- ... . . . ..: Private ............ ~. .... Water Supply: Public System and name . ".-.y-___.----. _" - - i � y Lo.. Character of soil to a depth of 3 feet: Sand❑- Silt❑ Clay ❑ •Peat�j ,7-Sandy Loam ' Cloy Loam[] Hardpbn❑ Adobe O Fill Material .(.Y - If yes,type ----- - --------------- -- - t , n (Plot plan, showing silo of lot,llocation of system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: lNo septic tank or seepage Pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size...__..._ ------------"-.:....---- Liquid Depth ...................--.--- Capacity ..... .............. Type ...._.. -- . Material....... - - ........ N Compartments _. Distance to nearest: Well . . --------- ' _ .. -----.-_----•Foundation .. Prop. Line......._- I Total ,Length _--------- ....._.. Length of each Ilne...:....? ------------ LEACHING - LEACHING LINE [ ] No. of Lines I i_.-.""" "" " D' Box............. Type Filter aterlal Depth Filter Mat ria - ..... Distance to nearest: Well ........................ Foundation . ...y�...------- .. Property Line § Depth �----_------..._.. Diame r Nu :. SEEPAGE PIT [ j p Number ....... Rock Filled Yes ❑ No O De i ✓ I Water Table Depth ------ -. ......----- Rock Size .. _ Distance to nearest: Well _ " . ...._.Foundation -----_Prop: Line . ( t � C t i. aZ�. to .i��_............. ]i REPAIR/ADDITION(Prev. Sanitation Permit;'` ......:..: ............ � �• Da . . ... .____._........" Septic Tank (Specify Requirements) "......... . kj Disposal Field (Specify Requirements) ....__14Db-_.....,T.9*----- - -Q^F -----'J'F_A.CN. ' -- �V----- EXI�aT nl .:.... PTJC=_--SSTM...x..s.-.:=-.:::. ._: . I --...-°•----- _._.._.. - .. ... . . - - - ' _ . . ..`:............ .............. - .. --------------- ' (Draw existing and required addition on reverse si e j i-,_...].-_.- application and that the work will be done In accordance with San Joaquin I hereby certify that T' haveisritpored this app County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or liven i sed agents signature certifie34hs following: P arson in such marmot "I cern in the perfe %1'c ",f he work for which this permit is,issued I shall not employ any P as to bac subject t ompensation laws of California-" i Signed/ y - - Owner / I - - �1 d----- Title ..... - :......._..........._.... (If other than owner) FOR .DEPARTMENT USE ONLY -7 APPLICATION ACCEPTED BY [ . :.0 s E;.._.... ...- �..---�- y�IT�_ YS�..o�.Q!��."DAVE-:,::-'..•..............' 1 BUILDING- PERMIT—ISSUED--� �L .... i�. . .--...l-h{----- � - ADDITIONAL COMMENTS ... - --=] _._. �_ Final inspe 1�.. ... ... -- . Date t i• • • ,� --�' `X, - SAN JOAQUIN LOCAL HEALTFt f)15TRICT- c u n i_'AA Qc„ AM