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FOR OFFICE USE: '' APPLICATION F=OR- SANITATION PERMIT 4 Q!---- Permit No. ._0 A/ r 'Complete in Triplicate) ' ---------------- - This permit Expires 1 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. 49 and existing Rule's and Regulations: JOB ADDRESS/LOCATION .- ---`�-(� --.-/-/--o--�OX----- / - r -- - -c:-1--A- ENSUS TRACT --------------------•----- /� C Owner's Name ' " (• .!_ � - ------------/---- -------- - --- ---Phone Address ------ t - -----. City ............ Contractor's Name ------� �--fes, ------------------------License Phone -- . Installation will serve: Residencejk<Partment House❑ Commercial :❑Trailer Court Motel ❑ Other -------------------------------------------- Number of living units:.`,,/__-_- Number of bedrooms __o'-- Grinder L�/p--- Lot Size ?�A�-`------ Water Supply: Public System and name ----- --------------------------------"'=----------------------------------------------Privateo Character of soil to a depth of 3 feet: '5and:❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;F Hardpans[ 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.) NEW INSTALLATION: {: o septic tank or seepage pit-'permitted 1f ma�y , public sewer is -avaiI'able within�20 0 feet,) ` Liquid DehPACKAGE TREATMENT SE�TTANKSizj x Cap cct *material No. Compartments --. -- -__._. ....Ype k _ - --- , __.:.._-._-- . 15istance to nearest:' Well/ ion - --------------_Prop?Lne -- _-- LINE No, of Line----- ------ Length of each line.-1-_ _ _ - -_ Total --engt�./ _____________ •� LEACHING. / - D' BoxG * Type Filter Material��.� Depth Filter Material ---�- ---------------- ---------------- V to nearest: Well -- ---- __ �- Foundation ----------- ---- Distance = Property Line .�> - t •w SEEPAGE PIT Depth - -_-- Diameter ----- Number ..-__ ----------------- Rock,Filled, Yes No 0 4 ..yy - X Water Table Depth ---------!_ ------------------------------Rock Size/6 ^--"� 4 Distance to nearest: Well --------011"e-1 -_----_----_<.......Foundation - l�_---_--_ Prop Line ! _._-_-.-__.. s REPAIR%ADDITION(Prey.%Sanitation Permit# -------------------------------------------- Date -------,- -----------_-__--� �} � �Se tcTank'(Specify T equirements) ------------IF " ------ ------------------•-------- Di po,sal Fleld '(Specify Requirements) r _' - - --- _ _ -------------------------------------------------- ------------- - - - - - ----- • -- a ----------------------- - - --------- - ------------ - ------ s (Draw existing and required addition ori re erse side_) — E hereby certify` that!I h ve prepared this application and th t the work w`ill'fbe4idone in' c cco'rd,nce%%ith Saa�oaquin County 'OrdinancesItatt Laws, and Rules and Regulations of the San Joaquin L�cal Health District. Home ownertor licen- lip sed agents signature certifies the following: "I certify that in the pe&)mance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------- ----- ---------- ------ -------- -- -- Ow er BY (If' -- ? nw------- - - mss - ----------------------1 ---: . it ----------------------------------- ----------------------------------.- er thaner.' 1 FOR. EPARTMENT USE ONLY i . APPLICATION ACCEPTED BY - mcp ;-------- DA�,TE ---p� � � 7 BUILDING PERMIT ISSUED ------- ----------------------------- -------=------- _ 'tbAfi.E ----- ---------------------------------- ADDITIONAL ------------------------ ------- ADDITIONAL COMMENTS --------------------------------- - ------ -------- ------------------------ --------------------------------- -- _ ' - _ I------------------------------ ---- - - ------------ --- .-- ---------------------------------------------------- Date y Final Inspection by: - - ---- ""� ,' SAN> AQU1N LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M.