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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. lCompiete in Triplicate) :............................. / Date Issued � �- 7� ................................411... ..---- This Permll Expires 1 Year From Dale Issued ,,?,Opplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the wok herein described. This application is made in compliance/with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/L ATION ..�a�}G . x�.. . .4 �t 'a�...,41� ......................CENSiIlS TRACT ......................... 1 Owner's Name ... ? s ............................................................. . _..,............._...... ..•... . Address -� ' 7n� ),-I '' ..... ....... City .:....2.� .......................................................... _.. Contractor's Name ._ �!�.I�s.e --- � :....License# � J� Pie installation will serve: Residencefitment House 0 Commercial❑Trailer Court ❑ Motel❑Other............................................ Number of living units*.....!..... Number of bedrooms ..�..-._Garbago Grinder ............ Lot Size � �•... ... Water Supply: Public System and name ---------I'll..............................................................................................Private E Character of soil to a depth of 3 feet: Sand❑ It❑ Clay ❑ Peat❑ Sandy Loom Clay Loam Hardpan j(Adobe❑ Fill Materia) ............If yes,type..............I ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: (No septic tank or seere pit permitted If public sewer is available within 204 feet,} PACKAGE TREATMENT ( I SEPTIC TANK Size.?-- ter'/................. Liquid Depth .�.. -- i�1 T �'l'-� .. Materlal.--"e.- -�-� No. Compartrnents ............... Capacity ,��D.-�.. .�C Type ---•-•- Distance to no est: Well ./ ,.........Foundation ....... E...-... Prop. Line _.7:: ......... 1� LEACHING LINE (k( No. of Lines ........3.......... Length of each line.......�}C� � J ... ._... Total Length .-,,1 . ......_.. °Q Type Filter Material .. . .... / .................................. 'D' Box .. ....._ ✓ Depth Fitter MaterialN Distance to nearest: Well ...... . Foundation ...... .... Property Lina .... ., ...... rn SEEPAGE PIT ( Depth --- Diameter ..... '�. Number .......��.._1../.,, .... Rock Filled Yes No CI . Water Table Depth � {/ %r p .Rock Size •••. Distance to nearest: Well ,�� .......Foundation ..... Prop. Line .... -. - REPAIR/ADDITION(Prov. Sanitation Permit# ........------------------------------------ Date .................................. SepticTank (Specify Requirements) ..................................................................................._...........................,............................ Disposal Field (Specify Requirements) ------------------•------.----------•---------------••-----•-------- •.-----:-----------.-.-- O ........................ .................. ................--............................................................ ...................................................... ............................................... ................................-..........................-..................................................--........................................ (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 Sore Jeaqvin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.District.Herne owner or Ilan sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l si►alt not employ any person in such manner as to become subject to Workm ' ompensation laws of California." Signed -- ---- ----- . • Owner BY /ll� -( �l _...... title