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FOR OFFICE USE: ,r FOR OFFICE USE: ;PPLICATION FOR SANITATIvN PERMIT ...-----•-------------'-" .. ...... '- ---..... - -• ' Permit No. (Complete in Triplicate) Date Issued_/,, t.&Pe�:-7-,q' •••-••.—...................-- ------------- This Permit Expires 1 Year From Date Issu f i Application is hereby made to. n L i r c ora permitlonstruct and_irf ta,11 the work herein described. This application is made in c mpliance with Co ty Ordin e No. 549 an exiRules and Regulations: --' JOB ADDRESS/LOCATION......-- ..yam - -1.....,. . ------- " ---- .CENSUS TRACT.. ....... ' Owner's Name.....-... - - Phone "----- Address ..-.. " Cit -------"----' Zip__,_.__ -- - Y .-..... : Contractor's Name...... - --- ---- -P- - - - License #. � __Phone ��f Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other- - - --- -------- ------------------------- Number -------- ---------•--Number of living units:....... --------Number of bedrooms-. ._--.. arbag'e: rider -y...._ .Lot 5iie.-.....__-_ _.- . .. Water Supply: Public System and name.. ... . ` !------ -------Privat ❑ k-.....y.. Character of soil to a depth of 3 feet: Sand . Silt❑ Clay ❑ Peat ❑ Sandy Loam E] Clay Loam ❑ * Hardpan ❑ Adobe ❑ Fill Material _ __.. ....If yes, type ............._. ._ . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on ever e side. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available with' 0 feet,( PACKAGE TREATMENT ( ] SEPTIC TANK ( ] F Size.-'-- .... ------------------------------------ --. -. Liq d '-'--- -- --------- - --- CapacitY ' . ..............Type-----•--------------- Material---------- ........ partmen Distance to nearest: Well------------------ .......----.--Foundati ... . rop. L' LEACHING LINE [ ] No. of Lines .- -----------------------_Lengthfof ch line .-�i; Tot gth 'D' Box----- . Type Filter rial --.----.Depaterial..... . . .... ...... . ..."-- --- ' -...._-.- Distance to nearest: Well '. ....... ndation-------------_---------... Line. SEEPAGE PIT [ ] Depth................Dia et . umber..-..-.------------.------.----- Rock Y s N Water Table Depth-- .--- --- --------------.Rock Size...--" .......... .-... Distance to nearest: -----------------..............------------Foundation.........._....' op. Line------......_. j REPAIR/ADDITION (Prev. Sanitation Pe itE#-----------___-------------- - -- -'-- ".........Date........----"..'................ --"-.---_--) Septic Tank (Specify Requirement v Disposal Field (Specify Requiremerits)..'m:'....L.-�- ------'� L� .. ---•------- ------------------------ --- ---------------- .. ---- .... -- ice - - „rt ,E ___ (Draw existing and required additiori ori reversye'side) I hereby certify that I have prepared this application ancl`thatAthe work'will be.,done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations-•of tlie._5an Joaquin Local Health District. Home owner or licensed agents I signature certifies the following: "I certify that in the performance of the work for which thi p emit 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..-- . --'--'......-' ------ ---------- ---e(i'-.....BY s i (if other than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- '% ........' ................. DIVISION OF LAND NUMBER............... . .................DATE...--------........ ADDITIONAL COMMENTS............__ ...... .............. ------- --------------- ---- --------...--- ---------------------- -- ----------------------- ---------.................--------- --—'-" --- ------------------ ---' ----------------- ..-- --- . ..------._ Final Inspection by. --"................. . .. ....Date..... ---•---- ---' ----- EH 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT F&s x�v�� aev. �i�d sM