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FOR OFFICE USE. APPLICATION FOR SANITATION PERM Permit No 7S 1 7 .................. ......... .ICetttplete In Triplicate) :..._ _. ...:. .:. r - Date Issued . . /� 7S :...... ............ ............ . Thls-PerAlt Expires 1 Year From Doti Issued' and Application is hereby mode to the San cam IiancecwiHh at.:oulth�yt0 d Ordinance rict for a NO. 549 nd existing g Rulestalnd Regulations described. This application is made o � ta +�sr !f:................. .. ...CENSUS TRACT JOB ADDRESS/LOCATION .. _-----Lrp—;� a ... rr�l_. .. . ..................:.... Phone _...._....._. ..... Owner's Name �v > 11 Ci �� ..._.4. ...............•----•---•-- - License --.--•-- Phone •----•. •---•- --- Contractor's Name .._. --••...... use.... .......... �railer Court Installation will serve: Residence©Apaitment H ❑ Commercial � } Motel ❑Other .......................... n - Garbo a Grinder Lot Size -•---` Number of living units:--__-_j Number of bedrooms ._._.------ 9 r v Water Supply; Public System and name __ .._.._...._.:-...._..--...--..-- C i ate ......................P ❑ Character of soil to a depth of 3 feet: Sand❑ Silt o Clay ❑ Peat❑ Sandy Loam fl lay Loam❑ e Hardpan[3 Adobe❑ Fill Matwlal .......:....if yes,hype............... ....... A I IPlot 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) r SEPTIC TANK } Size _. Liquid Depth •------•.................. . PACKAGE TREATMENT [ ] ------------------------------•---- •--• q . . I Material.. ••--- No. Compartments ...................... Capacity •---••..-.... .................... Tyne -•--�---....__._. ... Pro Line .•.. Distance to nearest: Well .......Foundation p• No. of Lines !� -_: Length of each line............................. Total Length ............... .............LEACHING LINE [ } 'D` Box ..__...._... Type ,Filter Material. ....................Depth Filter Material ................................. .. ... e Distance-to nearest; Weld ...-_= ••-----... Foundation _ :----••- •• #' Pro a Line :.. SEEPAGE PIT [ J Depth ._..--_••----•--•-:. Diameter ..__ Number .......................... Rock Filled Yes (I Na [1 I t Water Table Depth I� Rock Size •.--_-••------•- --•--- .Foundation ---- Prop.' Line ..................•... Distance to nearest: Well Date .................:........ } REPAIR/ADDITION IPrev. Sanitation Permit# .---.--.--•----------------------•-•----- . Septic Tank {Specify Requirements). : = - --........:.._.........�... f Dispos I Field ISpe '#y Requirements) f �` `':--- ........................... ................ {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 Sen Joaquin County Ordinances, State Laws, and Rules and Regulatieans of the San Joaquin Local Health.pistritt. Home owner or lieen- sed,agents signature codifies the following: o in such manner "l certify that in the performance of the work for which this permit is issued, I snail not employ any person Workman's Compensation law of California." as to become blect to Work P Signed .. �--•��---•-- -• � - ---------- Owner jitle $ ------•-•------------- .----- •....__ ...--.---_. -----•-- ..----- ................. iif other than owner) i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-...-- _-__------- ._.............DATE:....__"'._._._,._...------•--. ..---••=- �� .............DATE .................. .............. BUILDING PERMIT ISSUED----------------•--.._--_-_---------------- .. . .. .. . 1 ADDITIONAL COMMENTS ._ ................•--•-•-......-- --....._....,_._-.•.._.__..... fi ------------ ------------ ..... •---------- •---•------._...:-- ----- 1---------- ----- �. Tr - Date ..- final inspection bY: .._....-_ -.._ --- -- - 11 1 EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7�1 3M t I