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FOR OFFICE USE. ,, . RPLICATION FOR SANITATION PE ................... jj (Complete in Triplicate) _ Permit No -� 'A. DotexIssued .111-`77 `.a. . This Perim It Expires t Year From Date Issued -: .Application is hereby-made to the-San Joaquin local Health District for a permit to construct and Install the work herein a =. described. This bp'lii%tion is made in compliance with County Ordinance No. 549 and existing Rules and'Regulations, JOB ADDRI~SS/LOCATION .._..� _I�.U.r�...._._ a....-- �fy� / -/- -.... ...................CENSUS TRACT _.__._._`T................ Owner's Name ...... / ..... ..........Phone ' '-- Address ..:1 �V. ... � ''. t.... ........................ City XS".,4t7 i------------------------------------------•-------- 6ritractor's Name 4�T e � lJ�'z' .............. . --------.License 0*�.:3 "/I one installations will server Re idence art en) l �� fitu p til`ouse$ mmerc+4il ]Trailer Court' Motel []Other---------•---------------------------------- :s# Number:of living,units_____________ Number of bedrooms ..: ...Garbage Grinder ...& Lot Size.. RC_)�!V..::.............,.,.... � jVtater Supply: Public System and name ..............................:..................--.....................----------------------------• •-•---.Private , Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ . Peat❑ Sandy Loam ❑ ClayLoom & ' Hardpan(] Adobe❑ . Fill Material ............ If yes,type ............... ............ fplotlanjt showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)\I i NEW.INSTALiLATIOi�i: y(No septic tonk or seepage pit permitted if public sewer is available within 200 feet,) -V .O PACKAGE TREATMENT I ] 'SEPTIC TANK I Size-------------•---._____------ • ___.. .._ ...... Liquid Depth ......... Capacity _ -___-__-_. Type ____________________ Material......._.._..--------- No. Compartments -.-................... iLj iDistance to nearest: Well ____________________________________Foundation .:----------..__ ----- Prop. Line ---------------------- �. rLINE No. of lines LEACHING,.- [ j _.*t .---...-.-- length of each line............................ Total Length ............................ f 'D' Box ............ Type Filter Material ____________________Depth .Filter Material ............................................ Distance to nearest: Well ........................ Foundation .--.......f__........... Property Line ....................... SEEPAGE PIT I ) Depth :..... ............. Diameter ---_-___------ Number .....------ ................ Rock Filled Yes 0 No I[] } Water Table Depth ................................................Rock Size f Distance to nearest: Well ...............................•-.......foundation -------- ----- Prop. Line ...................... ✓ . z REPAI ADDITION jPrev. Sanitation Permit# .............:.............................. Date//- On. . 1 ' Septic�Tank (Specify Requirement ?. --, ea 4.. t . Disposal field (Specify Requirements) --- ---•--------------------------•-•- -----------------------------------.-------.-•-----------. ----------- (Draw existing and required addition on reverse side) I .hereby certify that I have prepared this applitation and that the work will be done In accordance_with San doaqutn County Ordir ances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or liven- sed agents signature certifies the following: "I certify that in the erfor ante of the work for which this permit Is Issued, I shall not employ any person in such manner as to become subje to �rkman's mensation laws of California." Signed _...-------- ----- --•-- Owner By ---------------- --------------------------------------------------- ............ Title ._.. - "la--_---------------- : .. (If other than owner) F R DEPARTMENT USE ONLY II `` �J APPLICATION ACCEPTED BY -------lis./.- --- - -------- -------- DATE ../ -, - f BUILDING PERMIT ISSUED . - DATE ... _'--1-1.1- .......................... ADDITIONAL COMMENTS ______________ _ •-----------------------.---------------------------------------..------- ---------------------.._...............................--.........I------•-------------------------- ................. . --------- ----- ------- --------------•- .--- -•----- _ I SAN JOA i into? inspection by: _-- _ ... _._._. -- ---------------•----------------------- •---• ------�-------©ate .._.J/.:...7.�-�------- - EH 13 2!s 1-6fi Rev. Q IN ?OCA! HEALTH DISTRICT $/7h