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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Peer ..... Permit No. 5: .._ `� ICompleto in Triplicate) 1 Date Issued .l.'.��:...- .........................I..._.._....................... This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordiance No. 549 and existing Rules and Regulations: I JOB ADDRESS/LOCATION ..�'I............ /. ..... .. .... . . ..... ..................CENSUS TRACT ...............,....... ... . _ �� Owner's Name ................ __.... f ..........Phone ------------------- -13 -------- .L..l..... Address _., 13- ...._ �, .r._...._.... �� City Contractor's Name ...;_ .` :. .... License # ..` 1 .__ Phone��1='...J. �C Installation will serve` r' - Residence Apartment House Commercial []Trailer Court ;❑ . kMotel ❑Other ...___------------- ----------- J y Number of living units:.../_ Number of bedrooms ...?---_Garbage Grinder ,-�-. Lot Size .� ~-•• Water Supply: Public System and name ... � � � .. ;.. Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 I Hardpan ❑ Adobe Fill Material ............ If yes,typ f (Plot plan, showing size of lot, location of system in relation Ito 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,) ,I PACKAGE TREATMENT [ SEPTIC TANK[ I �� Size-----------------------------.............._.. Liquid Depth ...---------__.......... € \,L capacity .. Type .................... Material.............. ....... No. Compartments Distance to nearest. Well . _ __..__.__--- ._.- _--------Foundation ..........:.......... Prop. line ..................... � LEACHING LINE ' No. of Lines ...�.. .. _ Length of each line...... ........_..__ Total Length ._. VJ �- __.............• 'D' Box__61_.. Type Filter Material . ....Depth Filter Material _ � .................................... o! Distance to nearest: Well r�GiJ�e Foundation Property Line .. .............. i" SEEPAGE PIT [ I Depth v �:...:._. Diameter rr Number . ....-.. ........ Rock Filled Yes No CI Water Table Depth ------ ..� _Rock Size -.v7-� ' Distance to nearest: Well ..........Foundation Prop. line ..,�` .E.......... REPAIR/ADDITION{Prev. Sanitation Permit# --------:...................... ........ Date -------------.--•-----------------) Septic Tank ISpecify Requirements) ...... ............... ----------'------- ' Disposal Field (Specify Requirements) . ,lLt'�c=.t� 1 ✓ / ✓ ......................... ....... .................... . .......... ------- ....... - --------- ........................... .... . ...... ............. i (Draw existing-,and required addition on reverse side) r I hereby certify that tI 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. Home owner or Ilcen- sed agents signature certifies the following: ' "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 .:.- . ... , .. Owner ' 8yU --------------------- 1 itie . ... (if other than owner) - FOR DEPARTM T USE ONLY APPLICATION ACCEPTED SY ._ '� � DATE ...... BUILDING PERMIT ISSUED -----..._..................•-- " . ......-.......DATE .. '..._..................... ADDITIONALCOMMENTS __- .....---- ......................... ..•------•.....�.................:..-.... ...,. ............ ............. ..."--------..._......... -................................ r--- -----•-•-------- --------- -------- --..._..----------..:...... -• --------------•--- ---------------------------- 4 .............. ....-- ------ ............. . . .f. ....��_ .............................. - - ... .......... ..------...Final Inspection by: ...- -- Date . SA,JOA UIN" LOCAL HEALTH DISTRICT 11 24 -moo o_.. r.. 7172 3 f