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FOR OFFICE USE:- APPLICATION FOR SANITATION PERMIT .............................. ........•------------ lCompfete in Triplicate) Permit No...�7... ......... ----------- .............. :_ J. . This Permit Expires t Year From Date Issued Date Issued ....... k Application is hereby made to the San Joaquin local Health District for a permit to construq and Install the work herein ! described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 56 7 JOB ADDRESS/LOCATION . ............. ........ . ....�C-a- -e�. ..,( ...................................CENSUS TRACT :.......,,................ f Owner's Name ... ®... Phone....... Address . . .-........-� ..... _ :. . t��.City ..........:...... .........,.-:.::-..• ............ - E Contractor's Name � • ��-�- -�•-:-.... .. ...... .. ................License # .1��3�� Phone ..............•.......... . Installation will serve: Residence�rtment House C) Commercial OTrallor Court E3 Motel Q Other................:........................... Number of living units:..... ..... Number of bedrooms _-..Garbage Grinder -•-• ............ Lot Size ...... ..... . ...... Water Supply: Public System and name -............................... -- ...Private Q� I Character of soil to a depth of 3 feet: Sand lF � Clay Q Peat❑ S andy Loam fl Clay Loam (3Hardpan ] Qbe p Fill Material •-•----••-• If yes,typo ............... ............ {Plot plan, showing size of 'lot, location of system in relation' to wells, buildings, etc. must be ,placed an reverse side.) NEW INSTALLATION• o septic tank or see a it ermined ifi�se'�w�)5 available within 200 feet,) • P P p P , '1 ` 1 PACKAGE TREATMENT ] SEPTIC TANK� f Sizer _. ................. Liquid Depth .,;Z.................. C6pocity 1, _ ........ Type •_______ -_ Material- -`'... No. Compartments .. .......... V111 Distance to nearest: Well Sa' T--------Foundation d Prop, Line . L LEACHING LINE No. of Lines -.....-. �..... Tata) Length ......------•_-• [ --------------- Length of each line---.._�o. ........ 1 zu ............ 'D' Box ------ Type filter Materia_ I .:.. .( .:...Depth .Filter Material ......-.-f4............................. Foundation --_...._l:-v... Property Line Distance to nearest, Well'-_ 4��. K 'J . SEEPAGE PIT Depth ____7.____-�. Diameter _... .. Number ..... ......... Rock Filled Yes 01 No Water Table Depth ®_ . "....:......:..:.....Rock Size ._.� .. - -••'.......-- --- Distance to nearest: Well .............. Pro Line.24 . . . .. �. REPAIR/ADDITION(Prev. Sanitation Permit gl` " .. a .....--• -•------------------------•-------. Date"................................... . Septic Tank 15pecify Requirements) .............. DisposalField {Specify Requirements) ----•---•-- •------ ---•-..... ...- •--••---•-•-......... -•---•------- --•--------•.......................... ......•-- ------ ------ ------------------------------------------ -----------______ (Draw existing and required addition on reverse side) . 1 hereby certify that 1 have prepared this application and that the work will be done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health.District. Horne owner or licen- sed icemsed agents signature certifies the fallowing: "I 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 to Workman's Compensation laws of California." Signed -•- ---------=-----------_-.(Q.. . -•-• ----•----------------------- Owner BY .-----••-- --- •--------- -`_�`�-F- ---•--....__.. Ji#le (I€ other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.. _ --•------------- ------•--- 7------------------------------ ------- DATE .6' x.-7.2... -- _....I—..---_ BUILDING PERMIT'ISSUED --------- �N-- -------- .......... - --- - ,-. .. .. .. " .. -- - -...-•----------- ..........................•---�--•---DATE .......-..........................-= ADDITIONAL COMMENTS -------------- --------•-_•-----------------------_--_................ --------------- -"------ •-•••.------.......-----------=---- ............................................ ---•- ----------------------.--- - --•----•----•--------- --- - _....--- f final Inspection by: ------- Da 6 , ... .-------------- ----•....................................... �-_ -- EH 13 24 ' }feu. SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M