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r%.FK WrT X Vxs APPLICATION FOR SANITATION"PERMIT ..................................... ;- •, 1Compfete In Triplicate) Permit No. . 7...... ._..._.............................I......... F tssued aZ: :7 6 ........................:................................ This Permit Expires lYear From Date Datelssued � . Application is hereby made 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. Regulationsi ?OBADDRESS/LOCATION .... s CT ......... Owner's Name ..............l. � �/i�-•.tel . ............ .........._ .. +. 0 Address .........................�®.SQ .._ !' rP .---......_..Ci .. P ne Contractor's Name ...................�"' . ................................................ ..........__ ............_..License# ...... ...-'.-........ ..................... .... Phone .: ........................... Installation will serveh Residencox portment House 0 Commercial flTraller Court 0 Motel ❑Other........................ Number of living units:...... Number of bedroom: _....Garbage Grinder............ Lot Size Water Supply: Public System and name ........................................................_................ ...................... ....... ..f+rhrcrfe,� # Character of soil to a depth of 3 feet, Sand D Silt❑ Clay ❑ Peat ElSandy loam f3 day Loam © Hardpan p Adobe FIN Moterlol ............ if yes,type........................... (Plot plan, shaving size of lot, location of system In rotation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATIONr (No septic tank or seepage pit permitted if public sewer is available within ROd feet,) PACKAGE TREATMENT ( j SEPTIC ANK Size._....... . .. �.�.. -..... Liquid Depth S=.6.... ' Capacity Type -C- , Mated al.sr.---... No. Compartments .. .. ... ... v Distance to nearesh Wein f .._. .. G.SP Foundation l....... Prop. line ..t.. LEACHING LINE No. ai kine: , ................. _fen t i-..o ea rlin . ......... .... ... ... ... ......... t/ , g Total Length 'D' Box •--•--...... Type Filter Materia ... . Depth Filler Material ......��- - . Distance to nearest, Well .f ound ion ..../I Property line .:war. ... .P SEEPAGE PIT y O Depth .................... Diameter ................,Number ............................ Rock Filled Yes Q No fWater Table Depth ................................................Rock Size ....................... Distance to nearest: Well ........................................Foundation .................... Prop. line ..................... REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ............ Septic Tank (Specify Requirements) ......................................... ..........-----............................................._ ......... .�... . .........� Disloosal Field (Specify Requirements) # .......... .........................•--........................................I........... ............. •4- i�........................................................�...._._.--..........._...__.•...................._........................................................................I.................. .... Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dome in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Romi owner or lite"• sed agents signature certifies the following: "I certify that In the performance W the work for which this permit is issued, I shall not employ any person in such manner as to become ub)ect to man's Compensation laws-of California." 5:gned x... ......... ........•----............_. Owner . Title (if other than owner) f . 'FOR DEPARTMENT USE ONLY ) APPLICATION ACCEPTED BY -- i ............. .............................................. ................. DATE .Z. BUILDING PERMIT ISSUED ........ _ r .__ .. _. a. _... ..... ... ..... .... ADDITIONAL COMMENT -,��. �...... �. . ............ ......... COMMENTS . :. g.. . .. - ----.: xr._.. ............. �;.,.. .by:, -W ..................................................... ................. 33 24 1-60 Rev.`5�! SAN JOAQUIN LOCAL HEALT4'DISTRICT 8/7h 3M �