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FOR OFFICE USE: _ • APPLICATION FOR SANITATION PERMIT :.......................... (Complete in Triplicate) Permit No. ..,_...._•...-.----- This Permit Expires t Year ham bate issued Application Is hereby made to the Son Joaquin local Health District for a. described. This application Ts m de in comPliance with County Ordinance Na. Sd9 and exining Rules vttd ,.,.d, This Permit to construct and Inriall the worts herein l t�d-D ..i F'I_C�f-c t - !Z ' Asgulctt,ons. JOB ADDRESS/1.06TI Owner's Name Cc �. ' ... _ - 1�.:. _�_ � -��-•�......CEMEStIS TRACt'�'�'• Address ... ...... ....1. .- (V! .... .... Phan 0_7. Contractor' . _. Ir--...city a ... _.. s Name ...._.. .._. Lltettse # ,..�3��... ��-�x Installation will serve: Phone .T7t7�:'_f•�.{t?�� Residence Q Ala�ens F ousset3 Commercial f]Trallw Colon i] , Motel 0 Outer ..._.._. .. �.. Number of living units. Number of bedrooms ..._..__....Garbage Grinder Water Supply: Public System Lot Size 4�... ,Q,�. ! Y and name ............. ........I._ . ! Character of sail to ................... ............... ......:...... a depth nf,3#_eel. -�5d�t }3 "�llt Clay 1 - Prtvcte j� _... Pedit❑ Sandy Hardpan 0 Adobe t LI om� Clay Loam 9 Fill Material............If - yes;type........................... (PIa pian, showing�si� of tot, location o{ system in relation to wells, buildings, etc, inu'3f-bis ptaceil.-.ori reveres NEW INSTALLATION: �}Na septic tank or s'ee"` a it side.} Pr?9 P Permitted if public sewer is available within 200 i�t,j PACICgGE TREATMENT SEPTIC TANK ( p. { ) `' Size..__... ....................... ...... Liquid Depth Capoc ty .................... Type . _ ..... .__.... Material........._............ �No. �.....,............... ��(� Distance to nearest: ;kelt - - A"�✓ — etas -..-----•-- ........... ....._..._Foundation ....................._Prop. Lime........... .....:.... i LEACHING LINE '4- . ( 1} No. of Lines .. Lyng , ... ! of each line................... 'D• Box ......... Total`Length J:........:...:.. _"� ..... .....y ...Depth filter Materia! Typy i�iher Material .........:....... �~S}= Distance to i�teorest: i1 ,,, Foundation Pro SEEPAGE PT [ j'' fie th ... p Di P rt1! �r ameter :........... ock filled NcWater Table Dep Rock Size Distance to nearest,Well _REPr` " ......... -- Foundation •..... ...........)Prop. Una ...........ZPA` 5anig Se ---• ...... Date ......................... ecifYRequirements) { } Disposal Field r 3t a (Specify Requirements) .......................... . .......... . ...... --.... . ..... .... ........... ........... ... {Draw existing and required addition on reverse aide) --. "................' � I hereby certify that I have prepared this application and that the work will be dons In accordance With San Joagvto County Ordinances, State laws, and Roles and Regulations of the San .ioaquin LotaE Health,District.Nettle ewner or iiten- ____ eJ agents signature certifies the following: "I certify that in the performance of the work for which this perttttt Is issued, i shall net atn !o an' as to become sublect to Workman's Compensation laws of California." p y Y fx such.manner i Signed .......... ............... Owner BY- ...... .... ............... Jitle v. li oth r an owner} FGR #PARfMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED . ... ..._. . ....__. . ..-- ...... ... DATE ...............•------------- .....---.............. ..--- j ....... ...... DATEADD1TiCVAI COMMENTS _:_.:._.. ... ..................-. `:.... .._. ..'... .......:............ ...... ...................... ....... • ------•......................... d Final Inspection by- .,.-...... -13 2L 1.-bf3 ........._..Dote Rev 5M y-- „ SAN JOAQUIN, LOCAL HEALTH DISTRICT � �....... ........ j 8/7h 3M x