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LFORO .��. APPLICATION FOR SANIYAYI4N PERMIT Permit No: _.------------------- --------------------- (Complete in Triplicate) Date issuedThisPermit Expires 1 Year From Date issued- unt Ordinance No. it t and existing Rules and Regulations: ' hereby made to the San Joaquin Locale Health District for a permit to construct and install the work herein Ap�licatian is Y described. This application is made in compliance with Y CENSUS TRACT s`5 --__-_-. ,� ----------- p , 4 +9 JOB ADDRESS/LOCATION .-- - --7 - ------------------- . Phone nl R----------------------:-------- Owner's Name -------------- M1 City �R C/ = os _ , i 0 0- S �� l Phone -------------------------•--- Address ---------------- License # ---------.-- ------ Contractor's Name . )9-1 T1_PPI. -; -y artment House'❑ Commercial ❑Trailer Court `❑ Installation will serve: Residence p ` v - ) Motel ❑Other --------- --_- -- . -•_-- L� • ,�,� � _ Lot Size _ - -- - ! _____-°_Garbage Grinder _._--- Number of living units:.___!.____._ Number of bedrooms 1 i -----_Private ----- ------------- Water Supply: Public System and name -----------F-,------ Ej Peat❑ Sandy Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 fee : Sand❑ E Silt❑ Cay - - i - )Hardpan ❑I Adobe'❑ if Fill Material _____------- Yes,type _-------------- -------- - I laced on reverse side.i' + r etc. must be p +t (Plot plan, showing size of lot, location of system in relation to wells, buildings, OV NEW INSTALLATION: (No septic.tar k or seepp e.pit permitted if public sewer available within 200 feet,] r, Liquid Depth __ i f t SIZE ^--�-'�'"-f___- ---- - O k f` - ____ SEPT)C TANK' � ;' �— -.___.,.! PACKAGE TREATMENT [ ] + k O Mlrv�ST Materiul' R No. Compartments ------- Capacity ------ ----- - ---- 1 Type r .� 5 i__-+—-- /_Foundation ---40------------ Prop. Line i Distance fo nearest: Well _______ __-- 11► k �� - Total Length ---2 �----- i LEACHING LINE l!7 No. of Lines _------ --- -- Length` of each line__.-.- --- -- ' QG - Depth .Filter Material -----�9 ----------- ------------ i 'D' Box _�5_-;Type Filter Material_►_----:- ----- P 5 i►� I�'. ^f'r--- Property Line. ------- s Foundation -_------- O �.� 4 Distance to"nearest::1Ne11 . IQ - No . ' '-- Number --------------------------- - Rock Filled Yes R SEEPAGE PIT [ ] Depth Diameter Water Table Depth Rock Size c ~.. Prop. Line ---------- ----------- Foundation � Distance to nearest: Well------------------- -4 - - � ..r ______________ Date ----------------__-__._______ __ REPAIR/ADDITION(Prev. Sanitation Permit# = , ._.,." ,-. M `:�---_--•-._ Septic Tank [Specify Requirements) -------- - ;-------------------------------------'----------------- Al- 1 G1�.r S � ),W/—P ~---------=------- ��A c� Disposal Field (Specify Requirements) -=- 1 -- --------------- -------------•-- -------------b__°_------------------ -red' -----iV ----- g q ' s addition on reverse side) --- ------------------------- - (Draw existing and re u 1 hereby certify that l have prepared this application and' that'the�work w!I�bedone in accordance with San Joaquin County Ordinances, State Laws, and Mules and Regulations of the San Joaquin I.�oca4 Health District. Horne owner or licen- sed agents signatu a certifies the following: arson in such manner "I certify th tin th performance of th work for which this permit is issued, t shall not employ any p as to beco subi t to r m 's pensation laws of California." Owner Signed i -- - -----�`� --` ------ Title - -- ------ - ------------ - -�(If other than owner) �--�- - ., , k FOR DEPARTMENT USE ONLY 75�. c:, .:. DATE ------ ------- (2 ------------------------------------- ------------- APPLICATION DATE ACCEPTED BY __._-----1---�---- `- �- - BUILDING PERMIT ISSUED ------ -- { ------------- ------------------------ --------------- - -------------------------------- �ttL i ' ---------------------------------- ADDITIONAL COMMENTS ------'--------" - ---- _ = - -- ---------------------- �- - Gf' --------- �..^- - ---------------- -----._Date ----- I ------ -------------- -- - --- '-- -"--- --- - - - --- Final Inspection SAN JOAQUIN LOCAL HEALTH DISTRICT _ l.S2 1?av sM