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FOR OFFICE VSE: APPLICATION FOR SANITATION PERMIT ..............................:....._....-----•- ...Permit No. ...7..C• lCornplete,in Triplicate) .. _ This Penult Expires I Year Fronf Q to Issued flats Issued .��..:�. -2 ............ ...•---• , 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 Co ty Ordinance No. 519 and exist es and Regulations: i JOB ADDRESS/LOCATION ...CENSUS TRACT p. � -�. ...... Owner's Name ..........C.fl� _....... -,�, ..._..... .Phone Address ._.. r- 1 ,,,.��c, _ {{,yh_"..,...._. E , tea._ -� ` Contractor's Name . ................................License#.��..7,1J...-..7 Phone _ ---. Installation will serve: Residence �partment.l*#ouse❑ Commercial❑Trailer Court ❑ � ' Motel ❑Other-:--�..••--•-....... ....' ................................. € V Number of living units:......j.... Number of bedrooms Garbage G finder"` .. Lot Size _' Water Supply: Public System and name .........................--............................._........,............................................Private Character of.so€I toga depth of 3 feet: Sand❑ Silt 0 Clay _ _eat.❑_,, Sandy Loam.❑ Clay Loam Hardpan d Adobe ill Material .",11f yes,type ... ........... ............ - _- J (Plot plan, .showing size of lot, location'-of system it relation to wells, buildings,-etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage p€t'permitted if public sewer is availablewithin 200 feet,41W ? ' PACKAGE TREATMENT [ ] SEPTIC TANK{ ) Size..................... Liquid uid De h Capacity _t.........:........ Type,.-:n ........._.... M'a.terial. :. No. Carnpartments.:- ' Dis ance to LEACHING LINE Not of Lines nearesti Wye .'`Len th of each Eineoundation To...l... P�op� Line..................... [ ] � . S td Leg -• 'D' Box ---- Type Filter Material ....................Depth .Filter Material ............................................ Distance to nearest: Well ........................ Foundation ........................ Property Line ............. SEEPAGE PIT ;[ Depth .................... Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No iQ Water Table Depth ................................................Rock Size ..........--........ ...... 4 ' Distance to nearest: Well .......................................Foundation .................... Prop. Line ................... � REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date . _:-__.__.-._.___.._..:.._.•---_-) Septic Tank {Specify Requirements) '° ��G' �.•.. �� ........................ Disposal Fief Specify equirementsl ----------- .*. ........ :..... - --- - -- ...............-........................................................ ------------------ ------------------ ---y` � .....--• - (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinan s, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Horne 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 --..............--- -------------------------------•----------------------------------------------- Owner 1' - BY.- '-- ---------------------------------------------------------------------------- Title ..----------------------------- -- ............................ (If other than owner) FOR DEPARTMENT USE ONLY G APPLICATION ACCEPTED BY ------------------------------- •--•--._.. DATE ."7G. BUILDING PERMIT ISSUED ----------------------- -----.-DATE ..------------------------------------ ADDITiONAL COMMENTS .......:...... =.._... . ..._. ---._._.:-------•----- -------- .. ------------- • �- --- -- -------- .._...._.. -----w f ------------------- ....... ------------------------------ _----- - ........................................... -------------- ----------------- ----- Final ---Final Inspection by: - -------- - • Li: -----------------------•-Date ..... EH 13 24 1--613 J A UIN LOCAL HEALTH DISTRICT 8/7h 3M