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FOR OFFICE USE: APPUCATION FOR SANITATION PERMIT Permit No.-7jL.7&,7 ............. ........ 1comph"in Triplicate) ............ ..................... s F I' This"it Expires I Year From Dwo 1SWW Date 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 compliance with County Ordinance No. 549 and existing Rules and Rogulotionst JOB ADDRESSA TION IQ.". Y � TR.A= .......................... Owner*s Name ..... . . .... .... .........L..........................................................Phone .................................... Address ........ ooi.,O d� .. ...... ....city .... .................................................. . Contractor's --.1 1 J141 # 45k?Phone Installation will serve. OfApo"House a Commercial 13Traljor court (3 Motel0 Other............................................ Number of living units:....-l... Number of bedrooms .....O�.-..0 ... arbage Grinder ............ Lot Sin ..... ...... Water Supply: Public System and name ............................................................ ....................Clay Private Character of soil to a depth of 3 feet Sand t3 Slit 0 Clay 0 peat 0 Sandy Loorn Loom 0 Hardpan 0 Adobe 0 Fill M6terlal ............if yet,type............... ............ (plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK f I Sin................................................ Liquid Depth ....................... Capacity .................... TYPO .................... Matwlal...................... No. Compartments ...................... Distance.to nearest. Well ....................................Foundation ...................... Prop. Lint ........ ...... LEACHING LINE No. of Lines ........................ Length of each line..................... 3� ....... Total Length ............................4 V Box ............ TYPO Filter Material ....................Depth Filter Material ........................................... Distance to nearest; Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT Depth .................... Dkwnotor ................ Number ............................ Rock Filled Yes 13 No Water I Table Depth ................................................Rock Size ................................ Distance to nearest. Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION{Prov. Sanitation Permit#............ ------------------------------- Dato .................................. Septic Tank (Specify Requirements).............................. .................................. .......................... ................................... Disposal Field (Specify Requirements) x2., F— V- ........... .......•. : ......................... . ........... .................................................................................. ................................................... ............ ..............-................... ..... ................... l0raw existing and required ItIon on reverse I hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County Ordinances, Stete Laws, and Rules and Regulation of the San Joaquin Local Health:District. Hem owner or 11cm sod 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 subject to Workman's Compensation laws of California." Signed .... .......-.................... ..... Owner BY -----------------------------------------------n2X Title (If other than owner) .................................. It DEPARTMENT USE ONLY ART" APPLICATION ACCEPTED By-- ....... ............... �DATi .................... JrI2 ....... ...... ------ BUILDING PERMIT ISSUED ............................. .. ............................... ADDITIONAL COMMENTS ............ ....... .....DATE .�.................. ............. ....... ............ ........................... ............ ............ ............................ ........................................ ....... ...................... ............ ...... ........ ........... ...................... --------------------•----.._....._............. ....... .... - ------------------------------------------------------------------------ ...... inal Inspection ... ..... .................. . —........................................................................ ..........Dot EH 13 24 1-68 Rev. 5m -------------- .......... SAN JOAQUIN LOCAL` HEALTH DISTRICT 8/7h 3M