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T FOR<OFFICE USE APPLICATION FOR SANITATION PERMIT � , .........,tj........... ...............I...... Permit No. lComplete In Triplicate) � / .........-•................................. S' 74, r Date Issued - This permit Expires I 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 described. This application is made'ln compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ./ CICO 9 <__• ...- 'i ....................................CENSUS TRACT .......................... Owner's Name .... �. ....+K £�%S!.......... . ........ Phone fd ".0.7f ............. <�dclress .. .....-_...........f.... - .- ._......_..Cit!/ .. .............. Contractor's Name ... ....••---...License tl ,z..... Phone installation will serves Residence Apartment House(] Commercial❑Trailer Court 0 Motel ❑Other Number of living units:.....(...... Number of bedrooms ..:�;-:...Garbage Grinder ............ Lot Size ...1......-•...... ....•......... Water Supply: Public System and name .......... -------...........___...................w.._....._..........................................Private Character of soil to a depth of 3 feet. Sand n Silt❑ Clay (] ,P t❑ Sandy Loam fl;_.paY��!n D. Hardpan Adobe Fill Material ............ if yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings;`etc..must be placed on reverse side. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) _ ...::................ Liquid Depth .. :�{ .........O,I PACKAGE TREATMENT ( SEPTIC TANK Si ...... !x.'. .... •• Ca aci T e Materlal..S No. Compartments ....---•-••-- Distance to nearest: We � .................fOundatian ls'�........... Prop. line -EACHING LINE No. of lines ----- ..........4.. `Length of each line ..:... ............. Total Length ..1:?ra.�............ 'D' Box ...Y......"Type Filter Material . 0 � Depth Filter Material .....�&.............................. Distance to nearest: Well _4.f ............. Foundation ....IA-"" ......... Property Line .............. ....... ...1�r. ... Rock Filled Yes P No ...___. Diameter .�r::... Number ........ ......... SEEPAGE PIT Q D Depth .... i Water Table Depth ...........................f .Rock Size .y. .x.� .�.......... �, • r Distance to nearest: Well ....... Foundation .....1�.. �' Prop. Line ....747......... { REPAIR/ADDITION 1Prev Sanitation.Permit# .............:.. v ........................... Date ..................................I peptic Tank ISpacify Requirement's) .................... ............................ ......................................................... 11VDiGosa! field (Specify Requirements F ' .............................. -._� ..........-.....`..-.-._.. _ - _•...---......_..------...._.-�•r�........----.... ._.' ...--._...... ..._.-...i . ............I.............. .... ....... ......... ....... •-•-•----..__........----......--------... ...... ................................................... (Draw existing and required addition on reverse sidekr 4. 1 hereby certify that (have prepared this application and that the work will he done In "deColddnse with San Jeagvin County Ordinances, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner as to become subject fio Worliniin's Compensntlon laws of Csillfornlia:' -anec ......... -�...:.... ..... .. ... . ... . Owner i BY . .. . ._..._. ....: ) :.:..... ...............::........ Title ---.....................•......... . . o er than owner Ih FOR DEPARTMENT 'LIST: ONLY APPLICATION ACCEPTED BY DATE -....- ....... .......-.•- t BUILDING PERMIT ISSUED .....................................,................................. ..._.._..DATE=.:...................---.--............_... ADDITIONAL COMMENTS ...... ..........>. . .. -----------------------""----................................. -•.................. ..................._...... ....... ........................... ........... FinalInspection by: ... t.................................. •.................._.......... ......... Date ". .......... EH 2! 1-•6li Hcav• 5�S SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M