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FOR OFFICE USE: r, APPLICATION FOR SANITATION PERMIT ..............�.��......._...��!_�.._.. Permit No. . lComptate in Triplicate) t- .......... . ... .................................................... This Permit Expires ]I Year From Date 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 ....! .. �.�__.......':�_..__._.... ....._-+- -..................................CENSUS TRACT ... ...................... AC 10 Owner's Name _.. .... .fi ---•-•----•-------•..................•----... ..._.... hone .................................... Address ..,_. .. .. _--...._C_y_...------ ~�__ ---- .. _s . .., _ ' , � L �. .......... Contractor's Name __.License # �� Ll_' _l'__. Phone -- -- ---- i Installation will serve: Residence IkAportment House C] Commercial(]Trailer Court 0 t Motel C]Other -----------•..........•-•--------------•--- , Number of living units_____________ Number of b draoms __.._..:Garbage Grinder __`e�`_-._ Lot Size Water Supply: Public System and name .--- _-, R -_-- _ -- •---••--------- ......................Private 0. }. Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay .0 Peat Q Sandy Loam ❑,` Clay Loam ❑ 1 F Hardpan 0 Adobe dq Fill Material yes,type - JPlot 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,J s f . liquid..Depth.- . 1..:. _. PACic9GE T.RE9TMENT,,,[�,,....SEP_TlC TANK_" .c:ze_••:-:•:- :1-�-:�..�..,.-X��I:.:�._,._ Capacity/..6.__6.44 Type A3= 664material..6t __ _ No. Compartments -- --- ..... ` Distance to nearest: Well' _- =- Foundation ----/ ---�....- -•-- LEACHING LINE 01PNo: of lines r-r ' ii_Ve Length of line .... :. .. ............. Total Length 'D' Box ! iYpe Filter Material AtA--_Depth Filter Material ......'l_v:�.- '........fir I Distance to•,rfearest: Well __{ ___..: Foundation _.� ............... Property Line-. ...._ . _. _:.� ` = g iNo . �. SEEPAGE PIT! Depth ' � _f:_ Diameter 2_0._f . Number ..__., .-,-•.............. Rack Filled Yes lNo r *� WateK-Table th �_ ` s } ` ' p Rock Size o ---------/ ......... �— ca. foundation mop. Line ....: Distance o nearest: Well ._. .1VV_ _ .-_ - /f REPAIR/ADDITION#Frau. Sanitation Permit 5 ------------ ------------------- Date .................................. ------------ --•- . , Septic Tank (Specify Requirements) r Disposal4Field (Specify Requirements). .• ----------•------ ........,._-----------............... ; �:..._. -•---- ---------------- w s � < ` (Dra existing-and-requiredaddition orereverse~side)-^` I hereby certify that I have prepared this application and that the work will be done in accordance with San ioaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lieen- sed agents signature certifies the following: , i_certify that in the performance-of the-work for-which-this-permit is-issued,-.t-:hall_.not.employ_any tserson-in-person as to become subject to Workman's Compensation laws of Californit Signed .-- Owner By .._.-.. � .. I:� —~` ----_ Jitle ------ ----- ------ ----- (If ---- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. �' BUILDING PERMIT ISSUED f ----••-- ---------------��.... --- ...... TE _ .................... � ADDITIONAL COMMENTS ............... - r ------•------ --- - ..�- -----------------------------•--_••--.-"-•---•---- ..._._.._.. - -; ------------------ ,/� 7 -- ----- ......... l_el final .Inspection by: _.__.__�Y_: .- Date _.... ../.7. -------------• Eli33 2 ................................1. ....__ _._ ._.. .__. -- 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M i