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FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT 10----------------- l9omplr,#e In Triplicate) Permit No. . - ----Le_ ..................... - Date 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 N�)described. This application is made in compliance with County Ordinance No. 549 nd ex sting Rules and Regulations: q JOB ADDRESS/LOCATION . 2�"" cte d4 --.. - s CENSUS TRACT Owner's Name -----.. ._. � .-�.11_if� � ....... ............ Address :. ._... ................ --•P�©-•---�. ....._...... Phone • - _0... .... citySGL Contractor's Name _____ !•. ( -S-2t�cJ1%— License # Installation : ..l.-7.3_. Phone ...546 will serve: , Residence❑Apartment Housef] Commercial Praller Court C] Motel ❑Other._..._..... Number of living units:- .__. Number of bedrooms Garbage Grinder-Grinder",. Size WaterSupply, ............................................ Ap Y: Public System and name ............:.... ........ .......Private ' Character of sall to a depth ---........................{ •Clay Loam . p of 3 feet: Sand❑ Silt[) Gay [j Peat❑ Sond Loam l Hardpan ' p ❑ Adobe Fill Material ............ If yes, type !Plot pian, 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 U PACKAGE TREATMENT j ] SEPTIC TANK• t t �) Size:_..�..?C .. __....._ 1� ---� _._. ..-- -- Liquid Depth ...3��'" Copaci .............. I Type `'Material.._ o• Compartments �.- Distance.to nearest: Well •••�•••- --� • � •-• ---• --Foundation .__ ........ Pro LEACHING LINE p. Line ..... 40' r �" No. of Lines --------;2 length of each line....../Q �•""---..._ Total Length ..6 ,�1Z!:-•• D' Box Type Filter Material _c,.S" '. Depth .Filter Material ....... � Distance to nearest: Well _ ....... Foundation �� SEEPAGE PIT �� -•-------•• Property Line ._-_--• De th � ._._....... ' -------.-- P �..._. Diameter ... ._ Number - --.•----_--.. Rock Filled f Yes No Water Table Depth __..__-___-. t °3 �-••-•----------------••--flock Size ----• �?r:......... �. . Distance to nearest: Well ... _-Q!--- ------ Foundation _.:_.fF�..f.__ Prop. Line ..,es�..s...--..P EPAIR/ADDITION(Prev. Sanitation Permit# __.:---------.--------------..........•----. Date ------•--•--------Se tic Tank (S ecifYRe uirements) ............ •- ) Disposal Field (Specify Requirements) ---------------- ................................................. •-----••-•------•--------- -- --•- --• - (Draw existing and required addition on reverse side)........................................................... [ hereby certify that I have prepared this application and that the work will be done in accordance with County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health.District. Home San Joaquin owner or Iicen• sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, ! shall not em Io an `_ Sto become subiect to Workman's Compensation laws of California." p y y person in such mpnnet igned -_Cr2 M -•----T Owner BY ....... __.__- ;Title ----------- - -----• (If other than owner) FOR PEPARTbtENT USE ONLY APPLICATION ACCEPTED BY {-;-- -". - BUILDING PERMIT #SSU(=D --- . DATEQ..7.. _. ------------------- N ADDITIONAL CO ET S DATE _�/:�.._ ..._-----Y-------- •----- -------------------------- ---------------•--•-I.-..._..._.I..----. I---....----- -- ---- --------------------•• -- ---------...... ...----- .............._........... ...--------._.._..--- .......... Final Inspection by: -----••-_.._.. • 1 x.. �C�� G - EH 13 2� J-6l3 v. Crate l �� ........... ..... `SAS A LIIN t�AL HEAI.y DISTRICT 8/7h 3M f