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FOR OFFICE USE: AMICATION FOR SANITATION PERMIT ............................... ........... ..... Permit No. ..?-C_ .t w - -IC*mpleto in Triplicate! ....._.. ... _ �. ,. ................................ ......... ... ........ This Permit Expires t Year from Deft Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal the work herein described. This application is made ' compliance i County Ordinance No. 549 d existing Rules and Regulations= JOB ADDRESS/LOCATI .._..... .....:..._. ,.....'z'-�.......... ...,......CENSUS TRACT .......................... Owner's Name ....... . C .........:......I............... .. ...........Phone .................................... Address ............ �-_. . ................City .. _. _ .............................. ........................._... Contractor's Name ...lr"'"� ... ...fir .. _ Lioanse i! �,/ .�. Phone ......:....................... Installation will serve: Residence�rtment House CQ Commercial 13Tralter Court El Motel o other............................................ . : .. %! /' Number of Irvin units: 1 Number of bedrooms .. .........Garbage Grinder % . Lot Size ....1 ............ Water Supply: Public System and name ........................................................_.. ......................................Private �1 Character of soil to a depth of 3 feet: Sand(] Silt o Clay Q Peat❑ Satiny Loam o Clay Loam 0 Hardpan 0 Adobe VFill Materlal............if yes,type............... ............ (Plot plan, showing size of lot, location of system In lation to wells, buildings, etc. must be placed on reverse slde.)� NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 200 feet,► / PACKAGE TREATMENT f ] SEPTIC TANK Size,V�,, ,k..5�............. Liquid Depth .... Capacity Type -.4P ... ...........- No. Compartments Distance to nearest: well ...... .. ................Foundation ... . �. .... Prop. Line - ........ ...... .. LEACHING LINE WNo. of Lines •- - ........ Length of each line..r' Total Length ........... 'D' Box . . Type Filter Materia( if ......Depth filter Material ... ......................... Distance t nearesk Well ......,�?.�........ Foundation --� :�........... Property Line -...-...�............ SEEPAGE PIT M'-' Depth ...... Diameter ...32.... Number ......Z---....... Rock Filled Yes G---90,(3 [} Water Table Depth ......../-40.(..•- ....................Rock Size ....1.1z..�. 3.-`�:..... Distance to nearest: Wel( .............. .............Foundation •-/.6..`.:..... . Prop. Lino .......... REPAIR/ADDITION(Prov. Sanitation Permitlit ............................................ Date ----! SepticTank (Specify Requirements) --_...... ..............._ _-------------...................................................................I............................ Disposal Field (Specify Requirements) •-•------------------------------------ ---------- ------------• --•---•----•••.-----•-----.......................-----.......---...------.........................---•---•---............................ ----------------------- ----------------•--------- ..........•--............................................-............................................................................................ (Draw existing and required addition on reverse side) 1 hereby certify that 1 have prepared this application and that the work will be done In accordance with Sae Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heath:District. Horne owner or 11cow sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, I shelf not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----- --•----•--- -• . • . --••---••---••----•-----•••-- Owner BY ._.".". ---....---------------------- Title �1..._ . (if other th owner) _ let ;ARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ---•- = ----------- ---------------------- .. ........... DATE �,1:- ------ BUILDING PERMIT ISSUED ------ . ... -•.................••-•...-... ........------�----- ...._...:_.....::.:.DATE ---- -----_--_--_ A DITIONAI CAMENTS .._ . ..-. _....0 ------ Final Inspection by: .. .--..--• ••...... •---- ...... .. ---- ........Dae .. -2,/f..� .. Off. --- E}I 13 2!� 1-613 ". S JOAQUIN. LCK L HEALTH DISTRICT 8/7h �3k