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FOR OI:FiCE•EiSE: APPLICATION FOR SANITATION PERMIT (Complete 16 Triplicate) Permit No. :.�d. ' ................. this PermitExpires f Year From Dah Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ./ ........ '... 1C 1 f CR NSUS TRA ......................... Owner's Name _. eIE'S._-. ---------6`1 ............................ -... .......................Phone .,...... .............. G Address .....:_.....- ........... Contractor's Name ._ ' . . f-- v!� ., censePhone.. sa';?� Installation will serve: Residence oApartment House Commercial{]Trailer Court 0 Motel ❑Other__....... ........... ........:......._ .... s (dumber of living units.-_/---- Number of bedrooms 4_.....Garba a Grinder.��-. Lot Size Water Supply: Public System: and name --•-....._.._. # :::`:..Private ..._..._.. . •--•-•-•--....-.•..•..................................... Character of soil to o depth of 3 feet: Sand E] silto Cla Y ❑ Feat❑ Sandy Loam-❑ Clay Loam`Q Hardpan Q Adobe 0 Fill Mpterial ............If yes,type ............... . (Plot plan, showing "size of lot, location of system in relation to 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,( 0 PACKAGE TREATMENT { ] SEPTIC TANK ] Size... n ,0._._ 411ieIV.......-- Liquid Depth ................. 4J Capacity )20.0--------- Type C}0M..CXC ateriaNo. Compartmentsc ...._. a` Distance. to nearest: Well ..__ ,,ryry ........... C.� .. .. :... Foundation 0•- Prop. Line .. .......... Cc% LEACHING EINE { ] No. of Lines __/..___.... Length of each fine-_A& ......_. Total Length ....� . . 'D' Box _.,�__.-- Type Filter MaterI f z.Depth .Filter Material .., �.. )A. ,( �t Distance to nearest: We ....... Foundation Q2s-1 1`)..... Property Line ,1 •....... _ ... . SEEPAGE PIT { ) Depth ---.-•--------- Diameter ......... ------ Number ----------- •------ Rock Filled Yes Q No 0- Water Table Depth ......:....... .....................Rock Size Distance to nearest: Well .......................:................Foundation ....... Prop. Line i REPAIR/ADDITION{Prev. Sanitation Permit# . .. ............ .. • . Date -_-- --•--•--•----•- _ --. ----- Septic Tank (Specify Requirements) .......... ._ __•--- �,,,_•' -d Disposal Field (Specify Requirements) ------ a,,,�R----- �� ' _. 1.. ^................ ( .Draw existing and required addition on reverse side)........................................................... I hereby certify that I have prepared this application and that the work will be done In accordance.with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which thisermit is issued, 1 shall` not employ an p p Y Y person in such manner as to become subject t orkman's Co ensation .laws of California." Signed _...---••--• - Owner BY ............... - -------- -------- w . .. Title (if other than owry ...-------- -••------ EP TMENT E NL I APPLICATION ACCEPTED BY ---------- DATE ...:.... .. ....7. ._. :__ -- --- ----•-•-•-•.... .... .... ................. ...... BUILDING PERMIT ISSUED -------------- ------- _--__...................... DATE _-.----- .•----------..-- __ ......_.._ ADDITIONAL COMMENTS ---------------•------------ - ---- 1 -------------------- ••-•-•------•-_-.... --------- - ---------------•-------- -•------------ ------ .......................•------------------ --------. ...... ............. • - Final Inspection by: . Date /?�... _.- ................ f 13 2b 1-6 lieu. 5M AN JOAQUIN LOCAL HEALTH DISTRICT /7b 3M