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FOR O F CE USE: APPLICATION FOR SANITATION PERMIT y[� � r _ �y� Permit No. ---••--•......... ....................... (Complete in Triplicate) { ---••--- Date Issued . _ This Permit Expires 1 Year From Date issued t to construct and install the work herein Application hereby' made to the San Joaquin Local Health District for a permi Pp is g Rules and Regulations: mo in com )ince with County Ordinance No. 544 and existi described. This a � f /g � _ - •-- I d. 9..................CENSUS TRACT .... .__._......_.. JOB ADDRESS CATION .... 'f �`r ` ..Phone ... ........ Owner's Name l- ,�:r7��.. ..................... . Cit ......... . ... r� ------------- Address L . #o4U Phone'.4 Contractor's Name . R i ence �Apartment House❑ Commercial ❑Troiler Court ❑ Installation will serve: Motel ❑Other "f �� 5 .A.2-J .od _5 Number of living units:.. .......-- Number of bedrooms .......Garbage Grinder tot Size Private "] 0 _., Water Supply: Public System and name .. ......----•---- '❑ Silt[:] Clay ❑ Peat❑ Sandy Loam [I Clay Loom Character of soli to a depth of 3 feet: Sand i y e -------- -- ---------- Hardpan Adobe ❑ Fill Material ....-." If es,type — buildings, etc. must be placed on -reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, `_) . NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 eet, " Size. ../r. ... ------• --- - Liquid Depth .J ....:.........�...! SEPTIC TANK PACKAGE TREATMENT [ ] No, Compartments ..__ r1UU✓ Capacity � p. TypMaterial - Distance to nearest: Well ��---...•--- -- Foundation . �----- ...... Prop. Line _.__._d__...---...` Length of each ....... Total Length /w-•..... ...... LEACHING LINE Len h line..[ No. of Lines �- g .i - // /�,, � .De Depth Filter Material --��-........................................ 'D' Box - -C. . .-. Type Filter Material GG.- �-- p � � Foundation J ', --.._...--- Property Line Distance to nearest: Well ..w �3- -----• . �`" De th �` Diameter �•..-_. Number -.... .............. Rack Filled Yes No p SEEPAGE PIT [ ) Rock Size/ Water Table Depth ------.. -------------- --•• d f Distance to nearest: Well .� d..-•.------ --- Foundation ....... - Prop. Line ................. REPAIR/ADDITION{Prey. Sanitation Permit# ---- Date ----.- ---- ) Septic Tank (Specify Requirements) ................ .............. ......... Disposal Field (Specify Requirements) --- ------- --------------- . . .................. .. ............. .. ........ . ...-- IDra'w existing and required addition on reverse side} i � 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaqu n of the San Joaquin local Health District. Home owner or licen- County Ordinances, State Laws, and Rules and Regulations 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 beco ublect to W Jkman's Compensation laws of California." ¢, - Owner Signed co- �� ...'... - ._..._•_. ..... .- ....._..._ Title . .... .. .... --- ... .. .._. ......�.. .... U- Com..................... ........ ...-..... (If other than owner[ f rREPkRIMENT USE ONLY _- ----- — ............. DATE ..2^. ` APPLICATION ACCEPTED BY ....._ � _DATE ..... --• �................ BUILDING PERMIT ISSUED .......•..._----•- •- -- ----------- ---• -•--- .-•---- ..._._...._ ADDITIONAL COMMENTS ._--------------------- .._ ---- ........ ............... ......... ........I..--•----••- .........._. -... ........... --------- ......................" ...... --.-._.... _ .4..p .............................. ................. . _... ._... •.._----_.Date .... 1-0• Final Inspection by: .._ --•-•------------•---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT C 3,112.3..M.