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FOR C)EFICE USE: i.... APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ..7 ..............-� This Permit Expires 1 Year From Date,lssued`% Date Issued ../............... r. ......... ---------- �` _ 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 corn plipn, 'i+vith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS%LOCATION+ -- ----.------ ------- ---- - ------ -- --- f..-. -_.. CENSUS TRACT ._._......_...._.......... Owner's ;Name ..... .. .�.. -. Phone 2 n Address 3St7xtiv - .:. . . - ( �.. ... City -- •-- ...............................' ` yt:.. Contractor's Name .. ........ .......... -Sb' --------------- ......License # ��a'.3`f -._. Phone d T-•_•- Installation will serve: Res iden �q(Aportment-House,❑-Commercial ❑Troiler Court C][�� Motel ❑ Other ..... .............. .•------....---------- _ Number of living units.,...[.._.'Number of bedrooms ._ 10 _......Garbage Grinder ........-... Lot Size _/��-x1. ___ . Water Supply: Public System and mime .............•..... ....... ........................................................ ....................Private Character of soil to ald!epth of Veet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam)• -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 reverse side.) ' d NEW INSTALLATION: (Nn s%_tic tank or seepage-p permitted if public sewer is available within 200 feet,) le J [ ) SEPTICTANK Size.....-:.+ :X..C1.. ..................... Liquid Depth . _- ...............:Ej PACKAGE TRI:ATMEI�TT tGa'pacityr .... _.. Type _.. _ Material..�� ? No. Compartments ......................�- . r P 00 D i s t ato nearest. Wel! .._. ----------------------Foundation ...1 Q.--•-.---.--- Prop. Line ... .... !...._..... LEACHING LINE No. of Line . Length of ealine�� fi� � / Total length ._. (.d.r.. D' Box ., ..0 Type Filter Material ____ ...... ...... ---------------- ___ ____Depth Filter �I•.. . I Distance r o nearest: Well .. 0.........-.... Foundation /t� �-- Property Line _. ti ' SEEPAGE; IT [ ) Dept ==_.. --- 0 Diameter ----•-----•_-:_. 'Number ---.--- Rack Filled Yes ❑ No Wate Table Depth .................................... ...........Rock Size ............ Distance to nearest: Well ..__.._•..............._.._I...._...._Foundation .__..-.._.. - Prop. Line ...................... I tf REPAIR/ADDITION(Prev. Sanitation Permit# --------.---_---------------------- ------- Date _._.........__ ........ SepticTank (Specify Requirements) ...._....- ............... .-----_._....----.......__..._......_..._..--.-.._...._.._......._......._..._._....._....,. - Disposal Field (Specify(Requirements) --- ..............................].............................--------------- ........ J --------- .. E . ---------------------- .............................. ' - - --- ---- - --------- -------------------- --------------------------------------- ------------ ----------------- ---...------------------ ...... � >. '� �.—(Draw-existing-and-regvired-add ition-on-reverse••side) I hereby _certify that I have prepared this application aAd that the work will be doAs in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or )icer-sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issuW, I shall not employ any person in such manner as to become subject to Workman's Compensationlaws of California." Signed ...°..... --•-------- --------------- Owner B f .r ,Title-o- ..`.- ............................ elf othe t tan owh e � # R DEPARt NT USE ONLY APPLICATION ACCEPTED BY DATE . - - ..'tea••.••• _ ..- ------- -- _ -- 7- ------ -------1-._.. , t BUILDING PERMIT ISSUED ..._..,. .. -----I..-y; . _...DATE .. .._...- --- •---- ........... aADDITIONAL COMMENTS --------------------- ------------------------•--`--------•------...--------`-------------.-.-....1-.....-----•. •----•--...............-----_.. ------------------------------------------ --------- --• --- -------------- -------------------------•-- - -- -- ----------------------- ------- i ` - ---- -- Final Inspection by -•`�' .................... . ---..`..... Date .. ... . Y .,.._.- e r .tel ::� "+ {� . .._ W AI If'1 A!'1I11 Ai I"I UZ A'I TU rUCTDIP'r