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`.__ . . FOR OFFlcE USE: APPLICATION FOR SANITATION PERMIT Perm o. ...... Pe it N I (Complete In Triplicate) Doti pFrom ! ued _ ._ T .. :............... ss E FI� This Permit too lms.l Year Date Issued .�i Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County'Ordinance Na. 549 and existing Rules and Regulations: ... .......... ......................... JOB ADDRESS/LO ION .—R 1..'.�--. ..�� ` CENSUS TRACT .r......... . ........ : .,. ...... ' - ..:......:.Phone�� . .. .. ......................... J, 1�- _ .. .....City Address . ..... .�T ,/..��..�.... .. .. J ...._ ,1......... .. .:...License # l: � . Phone ....... ........ Contractor's Name " ' _ �._ .... installation will serve:' Residence ff;Aportment House fl Commercial❑Trailer Court ❑ Motel ❑Other ............................................. Number of living units .....�._.. Number of bedrooms Garbage Grinder .......:.:.. Lot Size ....:......... Water Supply: Public System and name ...... .. ............................_....................................................Private E9 Character of soil to a depth of 3 fest: Sand❑ Silt I] Clay ❑ Peat❑ Sandy Loam C3Clay Loom ❑ I , r Hardpan Adobe❑ Fill Material .......I——if yes,type............... ............ I (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 see. ge pit permitted if public sewer is available within 200 feet,) � Liquid. De fh PACKAGE TREATMENT I I SEPTIC TAMC Si:e 1� , .. ..�.................. Q P, •.• ••.•................. f_ .__.._... T Material. ----. No. Compartments : .... Capacity Y[��' •��`'�=�'.r" ' ..... ' Distance to nearest: Wel! r! -- Foundation ...,1 L;�c. Prop. Line r� LEACHING LINE ( No. of Lines ti� Length of each line......r�� ...... Total Length 'D' Box ...-/'-----. T.' a Filter Material I�-_--.Depth Filter Material ./1.1 ....:•--••......•.......... Yp rg . Distance to nearest: Well 2...1�.� 4_t... Foundation .....- .Q. ... Property Line ....... .. . ....... Z -.3. ... Rock Filled Yes Na SEEPAGE PIT ['� Depth ...._�:.�_.j�Diameter ---� .�... Number ......... ... .......... Water Table Depth C ..hock Size ... _Lf— r Distance to nearest: Well ..:,:...-_ _...:Foundation .�?. Prop. LineZE 3.. ••••-• ... .... } REPAIR/ADDITION(Prev. Sanitation Permit# -..:..-- --------........_..-.``......---- Date....;............................ � -•• ��' y Septic Tank (Specify Requirements .... ...... ..................... ...............-............ ...... ........... f Disposal Field (Specify Requirements} f ....................................................------- .......................................... . ................:.:......................... ....... ....-.......................................................................... . (Draw existing•and required addition on reverse side) I hereby certify that 1 have Prepared this applicotlon�and"tkat the warts will be done lin accordance with Sen 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 this permit is Issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation taws of California." Signed _...- _:.. -r ...._ Owner ' - Jilts _..._-v+�� a-e �.v...__.... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -------•-= �-_---.-..--- •- ...-=-=- - . DATE_ ------ :,_„-•;. BUILDING PERMIT iSSUED •-• DATE ......_... ADDITIONAL COMMENTS ----------------- _---------------_--------- ......................-------...__....._................... ......... _ ... ---------------- _..-----. . . ------....-.............................. --------...._..__.....---•--. ............... _... .... ................. Final Inspection by: .... _ Date - fj Eli 13 2h 1-68 R&V. 5M, SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3H .