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FOR OFFICE 4lSE: iAPPLICATIOIZOOR SANITATION PERMIT ...........................I........................... (Cont tate In Triplicate) Permit No. ..................... • x p ! F Issued -Date Issued" ' ..... ............. ...... This Permit Expires res Year From Dole- i Application is hereby evade to the Son Joaquin Local Health District for a permit to construct and Install the work heroin described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulatlonse ' JOB ADDRtcSS/LOCATIO ..... Com" . ". ......I......I............ . ........ CENSUS TRACT ...... Owner's Name .............d. . Phone , Address ............ .�:'?:''.:.=�:-.............................. ...............................City._,._:4��'`'��',��.:.......... ..................... Contractor's Name .......i -------- ....................................... ........................... Phone .............................. Installation will serve: Residence Apartment Housefl Commercial bTrailer Court ❑ Motel 0 other . � � '�' Number of living unite:....1...... Number of bedrooms .. ._Garbage Grinder' Eat Size .....- ------ ••--•............... Water Supply: Public System and name ........................... ...................- » ....................................Privates Character of soil to a depth of 3 feet_: Sand 0 Silt❑ Clay ❑ Peat 0 Sandy Loam 0 day Loam 0 ` ` Hardpan❑ d Adobe s=ill Material............If yes,type............... ............ t�/ 4 7u (Plot plan,, showing size of lot, location of system In"relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic fank or seepage pt1 permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK j Size............................................... Liquid Depth .......................... Capacity ............... Type .................... Material...................... No. Compartments .................. Distance to nearest. Well. ....................................Foundation ...................... Prop. Linnet......f. ..._....... LEACHING LINE No. of Lines .......l.............. Length of.each each Ijne. �`0............ Total Letfigth z. .................. 'D' Box .._......... Type Filter Material .pt pth Filter Material `r! . ............................ Distance to nearest: Well . _ ..................... foundation ........................ Property Line ........................ . . Diameter ........ Rock Filled Yes No SEEPAGE PIT E ) Depth ................... ......... :.... Number ❑ ❑ Water Table Depth ........... ............. . ... ................ .Rock Size .....::..•._....�:.......... . Distance to nearest: Well ................. ....................Foundation......'.....::'... Prop. Line ........._........... � 4" REPAIR/ADDITION(Prov. Sanitation Permit# ............................. ............. Date .............. Septic Tank (Specify Requirements) ....................... ...... ....... • ...... ................ � Dis anal Field (Specify Require encs) ....... ........... ... .. '. ....... . . ............ .. .- .............Y.... .......... ..........__........._........__...... _ .... ... :- .. ..............._...................................... (Draw existing and required additlon on rover••' deI I .hereby certify that have prepared this application�dnd'that,ths work wili be done In accordance with San Joaquin County,Ordinances, State Laws, and-Rules End llegulations-of the San Joaquin Local. Health District. Home owner or licew ^ sed agents signature certifies the following: �� .- .y - .1 "I-certify that in the performance-efrthe-wo&-gor which this-paimitIs issued, I shall not employ any person In such manner as to beco . sub ect to Work en's C pansotton laws of California... Signed .. ...�. . 1 r ,;............................... Owner r By .........------... ...........................................• Yale ._......................................................... . ......... E (if other than owner) R DEPARTMENT USE ONLY / d;�:.................I.... DATE ... l.._ .� APPLICATION ACCEPTED �— L,..... - BUILDING PERMIT ISSUED .... .... ........................................................... .DATE ................................. ADDITIONAL COMMENTS ...... . .............. ..........................................................44JOAQUIN ......_...------........._...._............------•........._.._............................... :...................... .............._........ Final inspection by: ,-f'/rrp .. ::... ..........................Date .... EH C 3 2 1'bf3 Dv• LOCAL FIEALTH DISTRICT 874 3M