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FOR OFFICE USE: APOLICATiON FOR SANITATION PERMIT Permit No: { � (Complete in Triplicate) -------------------------------------------------------- iGSDa#e Issued -� --- - ---------.- ' (� This Permit Expires 1 Year From Date issued ----------------=------ construct and ,made to /he\-S�n J aquin local Health District nan a Nor. 5849 and existing Rules#all the work herein nd Regulations: Application is hereby, described. This application �s made in co pl;ance with County Or ` '._ - �------ � ( CENSUS TRACT - --- JOB ADDRESS/LOCATION Phone ------------------------------------ ------------ Owner's Name - mCit A Address - - � .3 i Phone ��j License # ---- Contractor's Name --.�J� Commercial :❑Trailer Court .13 I installation will server. Residence artment House F1 t , Motel ❑Other ------------------------------------ r --Garbage Grinder Lot Size Number of living units:_- `- Number of bedrooms -_7----- Private ri� e ❑ ' t Water Supply- System and`name ___-- t Clay Loam Character of sol to Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ i depth of 3 feet: Sand❑ e ----------------------- t Hardpan EJ Adobe' Fill Material -/ .-- if Yes,type ` etc must be placed on reverse side.) buildings, (plot plan, showing size of lot, location of system i} relation e m ttedof public sewer is available within 200 feet,) NEW INSTALLATION: {No septic tank or seepage p' p --__ All/' _ Liquid Depth `a� I SEPTIC TANK Si e S-- --X---: Q_�C_ / I PACKAGE TREATMENT L7 / -_- No. Compartments f '�`�� Type / .r l` Material I I Capacity ,• Foundation lU- Prop. Line k Distance o nearest: Well _____-_____ -------------- _ Total Length �-- -- •---------------- iNo. of Lines --a— Length of each line ^._ -�LINE [ ------------------- LEACHING I p' Box =- TYPe Filter Material l �--� ejpth Filte/Material --- - Property Line. --a�---- . Foundation _- -------------- - Dliistance to nearest: Well .....f-_- Rock Filled Yes �No 0 -- --- Number `._ '------------------ � _ Diameter .�-�-- --- � !/ De th __ - --- --- f SEEPAGE } ,p �' .3 Rock Size - =, I Water Table Depth ` Q / -- p .... - Vii• )�,� I" - --Foundation --- -- ----------- Pro Line i Distance to nearest: Well ------ ------ --------------- l ] # rte_ ----------- - Date REPAIR/ADDITION(Prev.%Sanitation Permit# ------ --- -- - ---Fr._ _. .� -------- - -------------------- Septic Tank (Specify Rec-uirements-1-------------------- -------------------------- ---------- Disposal Field [Specify Requirements) .� - --------------=------------------------ s ry _ » ------------- -" ------- ------------ ----------------------------------------- L in ------------"--""---- ---"------- I 'pF3raw existing and required addition on reverse side] ce I hereby certify that I haverprepared this application and of the San Joaquin Localat the work will be oHealth District.nHometowner or iicenh Son n County Ordinances, State Laws;and Rules and Regulations Y w e N sed agents signature certifies the following: arson in..such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subject to Workman's Compensation laws of California."k �e --------------- owner ' Signed - t E � � BY -------------------- ------- --�---- --- � - � ' ----- Title (If oth an owher) j ! FOR DEPARTMENT USE ONLY i DATE ------------- APPLICATION ACCEPTED BY i ---------------- - - DATE_.:_^:_� :-__.-_---------------------- BUILDING PERMIT ISSUED - ---------- - *`===P -' _" -- -- ----- --- -- -------==-------•------------------ ADDITIONAL COMMENTS ------ -------------- = -------------------- ----- ADDITIONAL - - --- ------ ---- ------ - - --------------- ------------------------ -" ll ' _ __ _ _ - - _ _ _ -----------=--------- r. ,. ,.� ` Data Final Inspection by: - - - ' SAN JOAQUIN LOCAL HEALTH DISTRICT kiCP r u 0 1_'AR [rev. 5M