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FOR OFFICE usE: APPLICATION FOR SANITATION PERMIT "0 .--ti2......... ..... .... .. � Permit No. ....._............... (Complete In Triplicate) .,,r�. p P ..... ......... .. Date Issued .S."........ ...__. ..:� _. ._...._... This Permit Expires 1 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 in complian5e 'th County .Ordinance- No. 549 and.existing Rules and Regulations. r • : f8Sy ^ - ....,LENSUSTRACT JOB ADDRESS/LOCATION ..... ber's I _..Phone .�_• r s Address ..... . r-------a..... 4 Name ......._ s .. ._.. License #o? ,� - ... Phone .. Contr�ittor s N a ..� - "'- t Installation will serve: Residence:Q Apartment H6use']-C-ommercial-QTrailer Court .a Motel Other . ;-=- - Number 5 w g Er .. of living units:...`.__ rr%15er of bedrooms �: Garbs e rinder _..sot 5ize:..,__.i............. ISystem - Private Q Water Supply: Public an name . .. -,. , .. Character of soi I to a depth of 3 feet.• Sand' Silt.Q -,C feat Q Sandy Loam Q Clay Loam Q .. ........ Hardpan 0 'Adobe ill Material If yes,type --------- ................. (Plot, plan, showing size of..lot, location of system in relation.to `,well's, buildings, ,etc. must,be.placed".,ori, reverse..side.) t NEW INSTALLATION: JNa'septic tank or seepage pit permitted if;public.sewer is available within 200 feet,)- .Sias........... .....:. _ liquid Depth �^� PACKAGE TREATMENT SEPTIC TANK[ ] " �.._---� ._..:"...... ' �(a - ........... Material p rtments' _.". ... { .Pauly- _•.---- �;- Ty ...... No. Coma � P ................. Distance to nearest: Well ............................Foundation .... rep. Line [ ] of Lines ..-----•_--=---.....---- Lengtli of each line--------- To Length ... LEACHING LINE No. •� D 'Box ------------ Type Filter Material .........:.......:..Depth F, Material Iter M �teri PI D stance to nearest: Well :.. foundation roperty-Line\ . . Number = . Rock Filled Yes ❑., No-0 Q SEEPAGE PIT [ ). Depth ----:_-:-----_--- Diameter! —_.:......-: � Water ;tpe rTable Depth. � •---• .............. .... RockSize ...............................- _ _----_-------- Foundation ... ._. _ Prop. ... ,. ne .Distance to nearest: Well , -- ............................ _ .._.... �:. ,... REPAIR/ADDITION Prev. Sanitation Permit�# Date ...._..•_:__.._.:.•.••.•-- } : t Septic Tank (Specify Requirements) :.__._...... _ - _ 6_ s. D I S p!7 al Field ,(Sp cif). Re irements) :...- -_---• 1 ---------- !.-- '----- ............................ r•' p `~ > }Draw existing and re quired'addition on reversp side} ;._ ,,- .,.;•.. . r r l'hereby certify that I have prepared this application and;that the vriork wil ."e clone in' accordance with Sail Joaquin County Ordinances, State Laws, and Rules and Regulations of the San�:i�aqui n Local Health District. Homeowner oi• lice"- .;. sed agents signature certifies.the following: _ _ ' i certify that in the performance of the work for whirr this permit :is issued,,I shall'not employ any`person in such manner I as to become sub;ect to rkman's Compensation laws of California. Signed � ...., Owner E.. Bye _..._._.... .- Ti,Tit : (If other tha owner) .. o s L ; I POR'DEPARTMENT -LASE ONLY :.._.._....•)'ATE ;S r 5 :`13 APPLICATION ACCEPTED BY _._ _.. I BUILDING PERMIT ISSUED ... --•• •. = ,.._ ..... ..DATE.... ... ...:.......... :: ::... I ADDITIONAL COMMENTS ................................................................•.._ rt........... -- ................::::::------ ._............._•. . ...... • ::::..... ••.••...- :::_.' -= ----::. .- -- . .......... :3: ::::::': ..... . _ ....------- . .� : : _...: = - Final Inspection by: -•- - . .. ...... :. ...: Date . ;.. C, .... .... a F SAN JOAQUIN LOCAL` HEALTH DISTRICT C' ' 7/723-M �, 11 24 , •co a..:, rAA