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APPLICATION FOR SANITATION PERMIT ............................................. lComplote In Triplicate! Permit No. ..77.E S.`.. .� ~_. This Permit Expire: ! Year lerorn Date Issued Dote.Issued_;:7..i- .. Application Is hereby evade to the San 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 Regulations, . ;, ..................., ty : . -JOB ADDRESSAOCAT€ON ....".....-.--CENSUS TRACT Owner's Na�.. ••�• ...._ ..................................................... . . ......P ..S...�....�• .. ........... Address -�- . .�' ... .......... .......... i Contractor's Name .. , ------•. ......................................L€cense # Ph .� one Installation will serves esidence Apartment Housefl Commercial oTrailer Court ❑ ' Motel[]Other F Number of living unites.......... plumber of bedrooms Garbage Grinder Lot Size ' Water Supplys Public System and name ..............•. ...... . - - . .__...........�— Character of soil ......_ ............Private o I to a depth of 3 feet: Sand Slit .Cla ❑ ❑ y ❑ Peat❑ Sandy Loam ❑ Clay loam (]. Hardpan❑ Adobe Q Fill Material ............if ye:,type............... ......... !Fiat plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) :.; ' NEW iNStALtAT10Na (No septi tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK Size . ..__._..... Liquid Depth I Co - _ pe ._ .. Materiaf. L No. Compartments .. --.._.. ' Distarice.t nearest: Wein .._��a..r- ...;.. ...Foundation 1 >......._... Prop. Line L NE ( � t i.nese ` A7 �-�.:.. f-�w -; ................... _ r. LEACHING I No,of I ' Length of each Ilne D Total Length �~1 r N ..: 'D',Box . .....r_ Type-Filter Material 6-• • . Distance to nearesh.Weli .1.aor:..... founclatiin .......:'. Property line ... .,,r.,..........0 SEEPAGE ( I ? Depth' Diameter `�--—Num#sery-- ��• . Rock Filled. Yah No ❑ F •� r Water Table Depth ----•••---.......`.............................:.Rock Size ........................_....... i • . 4 Well ........................:....:...: C r Distance !o nearest, . Foundation ................... Prop. Line . REPAIR/ADDITION(Prov. Sanitation Permit. ................ ........................ 1 ate __......r.........................) F: Septic Tank (Specify Requirements) ........................... F Disposal Fiera (Spedfy Requirements) ...............................�.. .... ........... .................................... ............ .. ........... ...............� ........................... ............ - ....................................... ......................................................................•--................................. ......, ..............................- ... .... ................................................................._.........................................__.:..........._..............:..................... i. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin : f County Ordinances, State Laws, and -Rule; and Regulations of the San Joaquin Local Health District: Hons"wner or [Icon. E. sed agents signature certifies the follawing: "I certify that in the performdnce of ifie work`fotl Which-this-permit-is-Issued, I shall not employ any person In such manner as to become subject to arkman's Compensation laws of California." Signed ...I.?�� ;.... . .. ..... By .................. Owner ; Y ,eta !acs /[• ...................... Title --- ........................ IV ! (If other than owner) 4R D ART ENT USE ONLY APPLICATION ACCEPTED BY...... ..7�7, ............ ..... . . .... DATE . a 7BUILDING PERMIT ISSUED "................ ..........•............_ ..........._......................---.............:.....DATE ...�.......::.::::..:'...:.....:............ ADDITIONAL COMMENTS _ .. .................................................................. ...............• ......-----.. ... . ._.........._....---..--......_._....................._.._.................................. { ..._... ............................. .................. Rev........... . .................................. ........................... ........... EH 13 24 1-68 Final inspection by: .............•---... . /4..__.. .. D . . ....................................................._............ ate ...... . ..I.. .. .ter..... SAN OAQUIN LOCAL HEALTH DISTRICT $/34