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RJK UFF€CE USE: - .......................................................... ........ .._.. ... ._... . _ _ _ APPLICATION FOR SANITATION PERMIT ...................•--........:.... -�, ....•........._ '(Complete in Triplicate! Permit No. ........................ - ---•----•-•-••-•••..........:..... This Permit Expires I Year From Dato Issued --..._....-- . . . Date Issued Application is hereby made to the ....... San Joaquin Local Health District for a described. This application is made in compliance with County Ordinance No. 549 and ext permit to construct and install the work herein JOB ADDRESS/LOCATION ._c?•?_3 sting Rules and Reputations: Owner' me CENSUS ........................ Address / d s/ ��'� _ ---•--•. --....Pho TRACT Contractor's Name J'/,��ir ........ ..... : City Q.er".4....... Installation ------.License ..... ................. will serve: ....__ Residence •--.....�............... Phone ............. Apartment House Commercial ]Trailer Court ] ............ I Motel 0 ' Other -•........Numberof living units:_ - ------ ......: '~•-•--•---• Number of bedrooms .- ---------Ga Water Supply: Public System: and name rbape Grinder ...._....... Lot Size Char -•-•=-••----•- ............................... Character of soil too depth of 3 feet: Sand ---..-............. --Private 0 V11 �7 Silt 0 Clay p Peat.O Sand ................ Hardpan 0 Adobe f . Y Loam ❑ Clay loath [� U1 �Fiff Mitterial..._......._ If yes,type............... ...... {Plot pian, showing size of lot, locat€on of system in relation to walla, buildings, etc. m •.•.-- NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer.€s ova must be placed on reverse side.) PACKAGE TREATMENT [ ] SEPTIC TAMC{ available within 200 feet,l Size...S_f; /a f'` capacity /boli ............................. Li J quid Depth ............ Ni Type ----•--------•-----• Material_C-s'i'b., Distance •--------- No- Compartments 7 I to nearest: Weil" .S� LEACHING LINE '---"---•-.--...__. -•-•--.Foundation -•................... Pra [ ] No. of Lines •----•---...-----•-• p. Line -- Len th of e z, R a line.._....¢- .._....... Total Length ....4-. D' Sox .. - Type Filter Material _/�. .._... _ Depth Filter Materia! ./ Distance to nearest: Well 11gq "� -- SEEPAGE PIT , -- ......... Foundation l4..� .-- -- GE PIT [ t Depth ?c�'f.Z$ Diameter Property-Line I... 3 !� Number -•• Rock Filled Yes� No C] Water Table Depth .-- .. _.. .....................•__ -•----••-•-------•. Rock Size --------- Distance ............... to nearest: Well 1 O f .... EPAIR/ADDITIO •---••'-......•. .........Foundation .1e.-`-. NtPrev. Sanitation Permit# •••-•-•-- Prop. ro Line. Septic Tank ....._.. . JS Requirements) . • fY quirementsJ _._._.._-- isposal Field (Specify Requirements) --------•- ...............................--•---•--•-••----•-•-•------...........--................. -- -----------••-• -•---• -------•••--••••-- —....._ .. ------•-•--•----•--- (Draw existing and required addition_on reverse side} .._.......I.._ i hereby cert€fy that 1 have prepared this application and that the work will be done in accord F County Ordinances, State Lawns, and Rules and Regulations of the San Joaquin Local nealt sed agents signature certifies the following.-, once with San Joaquin "1 certify that in the performance of the work for'which this permit is issued, I strait_ not h,District. Homo owner or liven. as to become subject to Workman's Compensation laws of California." employ ars Signed" P y y person in such manner ------------ Owner (If other than owned --........-_-- Title _..-.................... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --._- - : BUILDING PERMIT ISSUED -•................•----- ------ •-----....----- --- DATE • ---- - -- - ------•............. .... .... DATE ` -� 2- ADDITIONAL COMMENTS -_:-----------•_--- - -•-•-- - -- _._. • -••............. -----............ ------ ---•--•-•---•- --- 1 ----- -- ---•--------------�,"...............------- --------------- .._...._..._... Final Inspection b- -•---- ----- - •-VA ---••-----•------••--- ••- .EH 13 2h 1-6f3 Rev. SAQUIN LOCAL HEALTH DISTRICT - Date ... . / � - - 8/7h 3M I