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4 FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No. 7... l (Complete in Triplicate) issued ...`?...1:....vi— Date This Permit Expiresrl 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 i described. This application is made in compliance with CountOrdinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. . ..//.... fG.-..... �_...._. --•--.-•--•-..._...CENStiS TRACT .......................... r hone .! (o_. .. Owner's Name ..... /�---•------ --•--• City ... Address .._. .... �j� _ ..�. y / g i Contractor's Name . !t -�1! -�� 'a`` '� License #r, ,�./- -rl--�.• Phone T. �:��{•• Installation will serve: Residence partment House Commercial ❑Trailer Court .❑ Motel ❑ Other ..------. --------------------------------- Ila` Number of living-units:_...... Number of bedrooms ._, ....Gar ge Grinder — '.. Lot Size _!� liS�•--/ •r Private Water Supply: Public System and name ... - .- -.- -- rr ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ AdobeA Fill Material ...._..__ If yes.type ........ ............. .... i (Plot plan, showing size of lot, location of system in relation"to wells, buildings, etc. must be placed on reverse side.) f NEW INSTALLATION: (No septic tank or seepage pit .pgrmitted if public sewer is available within 204 feet,}01 �1 { PACKAGE TREATMENT 17 SEPTIC TANK t ------- ......................... ____ Liquid Depth .......................... S Capacity Type .................... Material-------- No. Compartments ...................... Distance to nearest: Well Foundation _-- -- .-----. Prop. Line ..................... LEACHING LINE �/ No. of lines �. _..- ... - Length of each line ....:. ••- Tata! Length _... .._p le-1-01 -.-DepthDepth Filter. Materiot D' Boxs'tF"- . Te Filter Material Distance to nearest: Well �� `` . Foundation Distance Property tine _...--••• f SEEPAGE PIT Depth .� ---• -Diameter -��--- Number -.- Rock. Filled Yes No 0 / _ _ r Rock Size .:.n�- --- ----------------- l' Water Table Depth _.._---��--•-----•-•---------------- --•- . I l Distance to nearest: Well . 1�. ----------Foundation _., �'- .-.----- Prop. Line .-_ .-----••••-- REPAIR/ADDITION(Prev. Sanitation Permit# .- ---- - Date --- -------------------- ----•) Septic Tank (Specify Requirements) - ---------- -- ---- .. ... __---- ------ ------------...-----._.... ..------ re . Disposal Field (Specify Require nts) ------------- -- - - _ --- -----------��!-- - - ------- .......... Disposal (Draw existing and required addition on reverse sideI hereby certify that I have prepared this application and that the work will be dens in accordance with San Joaquin I'+, County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nome owner or licen- 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 .... ............... Title .. .... ; (if other than owner) i ` FOR DEPARTMENT USE ONLY : . APPLICATION ACCEPTED BY .. _.. � .._ f DATE .... � ... .. .... _.._. . -. .. .._-_.�� -.� . . . ter... -�:.. �.-•-- BUILDING PERMIT ISSUED ._.... '.-..._ .......... _-__ _ - DATE ADDITIONAL COMMENTS ...... Y.................... ......... �l5--._ ....:..:---::._..-------- ---.. ........ ........... :...................::::::::_:._:::_._ ::: ::::� -....:T ..............� ....._ ... . .. .-_ ....... Date Final Inspection by: ..._... ... --•-- ----- --- .....Da �7 ... .._... . �� ,4 54N1JOAQU <LOCACy`i*IfALTFf DIS7RIC1' " r� 7[7:23',M