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FOR OF=FICE USE: i i APPLICATION ICOR SANITATION PERMIT , ... . Permit No.�'.�......::..:.....:.. ,> (Complete in Triplicate) Date Issued � .f.�- _••7� This Permit Expires 1 Year From Date issued - .....................:................................... 7� /1 yu Application is hereby made 1to edam compliance wiin Local th County ealth tOrdinance Norict for a m549it d ex sting Wes construct and tand Regulations:tein described. This application oma. ..- :.. ...T • • NSUS 'TRACT. .......................... ADDRESS/LOCATION .�... ......._. ••--• .....Phone 5 ........ Owners Na •-•--... _... ..- . City ............................ Address ...... Ph ....._.....� J'? �t� - ............................ License # 4� ... Contractor's Name .._�=t��--f- Installation will serve: Residence R Apartment House 0 Commerclal❑Trailer Court ❑ Motel 0 Other .. .............. ...... .....- •--• �Lot Size ..._._._.... ••.... `•Number of living units:-...2_ dumber of bedrooms __ Garbage Grinder . Private to l Water Supply: Public System and.nome ..............•-•----....... Character of soil to a'depth of'3 feet- Sand Silt❑ AClt ❑- Pt❑ Sandy Loam ❑ Clay Loam ❑ ea $ r ' Hardpan o Adobe 0 Fill Material ----- ----- If Yes,tYpe ............................ - ' buildings, etc. must be placed on reverse side.) (Plot- plan, showing size of lot,"location of. system in relation to wells. NEW INSTALLATION: (Na septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT i } SEPTIC TANK[ } Size.................. ... Liquid Depth ,p Capacity �a d- -••_ hype s Material)61 ml.. No. Compartments Distance to tnearest: WellFoundation .-- Prop. Line ...tom _•-•. ' ,--�.�� _.._.1� -- -•-•-- • t SCJ' . Total Length _0q/ 5. l ......... Len th of-gachtline.._..... c..__........ ,._. LEACHING LINE [ ] No. of Lines _.'.'__.. -- •••. g •y � FF---' .-" _`�.. Depth Filter Material .._... ............-•-•--- _ 'D' Box `....�..._ Type Filter Materia ••--••-- p / . r / � ....... Property Lir3e . Distance to nearest: Well .:..-.3J.-.__........ Foundation _ [ 1 Depth _ Diameter...........:..... Number Rock Filled . Yes ❑ No ❑ Water Table Depth . .................,..Rock Size ....... _._...... ,. Foundation Pr6p:.-Line .................... Distance to nearest: Well ......:..................... •-------••------••--- REPAIR/ADDITION(Prev. Sanitation Permit�# .- - Date Septic Tank (Specify Requirements) ,.. .... Disposal Field (Specify Requirements). `. •-••••---•-•. p ._......................................................................... ---- I : 9........................ -{Draw existing and required addition on reverse side} k will be dans in accordance with San Joaquin 1 hereby certify thaVI have prepared this application and that the wor County Ordinances, State Laws, and Rules and Regulations of the Son-Joaquin local Health District.dame owner or iiten sed agents signature certifies tiie following: ` arson in such manner 111 certify that in the performancW 0 the.work for-which this permit is issued, I shall not employ,aNny p , i as to become subject to Workman's'Compensatiain laws'ofCalifornia.Signed " 3 ....... Owner, - ..................... ........ ....... ��P.�i..�.C,'%le[• ,!�---., __ .,. Title ........................... .. ; m (If other than owner) "' f ;� R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... ... ................................. DATE ..��i- •- -.......... BUILDING PERMIT ISSUED ...: .:_ ........................ - '- ---• - -DATE ................ ....... i ADDITIONAL COMMENT�+� r4 C u✓� : - '/ e .. . .. &! .. ...._ ............... J : .......•---.......--•- ,� �,o►��_Qom........ --.. ........................................_ .._.... ...../ ' ---.:._---.......---......................pcste -� � ' r ...... • . Final inspection by, _ ....: ••• •-••--•-• M u F v .1 y SAN JOAQUIN -LOCAL. HEALTH DISTRICT 7/723 M r_ �. I-3 24 ,t 'Ln co—, rAA