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FOR OFFICE USE: .. ......... ...:..........._......_ APPLICATION FOR SANITATION pcAn QO0C�{ .. . ......... . iconiph"in Tdis"catel Permit No —. .. .... ........•................. This Permit Expires 1 year from Date lsssted Dam issued v' .. 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 Regulationse JOB ADDRESSAOCATICINN�© --•`. �. .j.. �.. .(..................................` �if..�...... !,:....CENSt�S TRACT .......................... ...... . . Owner's Name ....... . .// �. ._....... . ................. .............. ........--... ..................Phone Address .. ? ...-._�t_.��... �' .........................Ci �?i?%xye ...._.._ Contractor's Name .... .. lj ... .......................- �j j ..._ T l ,/'I� ,�•� - ..License# 440.G�s2�.... Phoma tfa�....�...�.� Installation wItl serve: Residence Apartment HoJto Commenaat 13Traibr Court 13 Motel Q Other............................................ P Ale�....... Number of living units:... Number of bedrooms ..yt......Garbage Grinder ..$.-... Lot Size ......... ! ...... Water Supply: Public System and name ....�........................ .._. ..------------....._.............._...Private(� Character of soil to a depth of 3 feat: Sand f Silt Q Clay ❑ Peat Q'•. Sandy loom,0 Clay Loam p Hardpan 0 Adobe 0 Fill M6torlat............if yes type............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed an reverse skis.► NEW INSTALLATION: (No septic tank or seepage pit permitted If publ sewer is available within 240 feet,! --------..._�_ f / PACKAGE TREATMENT [ l SEPTICTANK ] Size..........e+!.. ©:. � f ...._ Liquid. Depth ... .[..G. U; .. ..._.�..._r, Capacity --••-•.. 0•- TYPO ....j%!'.'.:j:�... Mc*wkd.._ ''?�� '.:�' No. Compartments ..L:. ......... Distance to nearest: Well .. .�..i'r.�. `................Foundation ...1.0�.......... Line_.. �' ..._..... . -•• - Prop. .. . d LEACHING LINE I l No. of Lines ........ Length of each Ilne..._.5.—.Z .r........... Total Length ..... .. .,........ 'D' Box ... ..... Type Filter Material t......A."e -Dopth .Filter Material ... ��! ............................ Distance to nearest: Well ....%.� ......... Foundation .../. . ......: .... Property Line .....'� ............ ,.- SEEPAGE t 1 Depth .................... Djornow ................ Number ............................ Rock Filled Yes D No ❑� Water Table Depth ....... ..................................... .Rode Size ................................ P Distance to nearest: Well .......................................Foundation .................... Prop. Line .................._. REPAIR/ADDITION(Prey. Sanitation Permit Dale .I Septic Tank (Specify Requirements) .................................. ............................ ............ :........ ..........----............. Disposal Field (Specify Requirements) .......• •••. -- • . ....... ................._......................... .......:.:........._....._.: ......:................. (Draw existing and required addition on reverse aide) I hereby certify that 1 have prepared this application and that " work wiM be done in accordance with Sat leagWn County Ordinances, State Laws, and Rules and Regulations of the See Jo"uln Local HeaNiht.District. Harte everter or Now sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued„ I shall not employ any person in such manner as to become sub(ec a Workman's p n laws of California.,, Signed................. •--• -- - ••--••-••--................_ Owner By --------------- . 3itle ....... if other than owned 4' � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...,. . : DATE ZS-7 . .. --. _.�r ........ BUILDING PERMIT ISSUED --- ---- ------- ...................................................... . -_--------...............DATE ........-.. ADDITIONAL COMMENTS ----- ------ --•- --....... ...... --- ---•- . . .........................•.. .............................._........... ........... ........................................ ....-_........................... Final Inspection by: •-- ... _. ..._ ••... ..... Date ... f- 5. 7 EH 13 2h 1-68 Rev. 5M -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 8,/7!I 3M