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rwK vrrlLe USE: - APPLICATION FOR SANITATION PERMIT (Complete M TrlpNcahl Permit No..7f ................ • ................ This Permit Expires t Yeas from Date Issued Date Issued ............"...... Application is hereby made to the San Joaquin local Health District for a permit to construct and in described. This application is made in compliance with County Ordinance No. 549 and existing Rule in JOB ADDRESSjIOCATION ...i.D-((�, SU UAMW .�. Owner's Name .. ..............CENSUB TRACT .........,................ Address 1 �.......................... Phone:�(' & .... ......- ._.......Ci c�a4 Contractor' tY .. . _...-.....- Contractor's Name . ... .r--�..�.,�1-tet _ .�' �o . ---••................License 10 .. Phone Installation will serve: Residence f-Apartment House Commercial ❑Trailer Court ❑ Motel ❑Other............... Number of living units:....../- Number of bedrooms ---Garbage Grinder .. 8... Lot Sized.. ................... Water Supply: Public System and name .... Character --• .............._...... ..Privatex atter of soil to ."....................... a depth of 3 feet: .Sand❑ Silt aa ......... ❑ Y ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ Hardpan❑ Adobe Fill Material type ............ if yes, ............... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plate on reverse side.{ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j PACKAGE TREATMENT ( ] SEPTIC TANK f I Si, e......................... .... Liquid De t Capacity _ Material. . Type ...,.-- . Compartments . Distance. to nearest: Well ..................... .. --- ---.--..---Foundation ---•---•.............. Prop. Line .............. LEACHING LINE � � ........ [ ] No. of Lines ---------------"-------- Length of each line........................... ' ----........ Toto! Length •D• Box ............................ . ............ Type Filter Material ....................Depth Filter Material .......................................... Distance-to nearest; Well ...•.................... Foundation ----........ SEEPAGE PIT --••••...... Pro Property litw ........................ [ 1 Depth ........... on ---_-•---- Number ------------- -............... Rock Filled Yes ❑ No ❑ Water Table Depth .._..._.".................... •................Rock Size �---•--•---.._.......... Distance to nearest: Well ........................................ .................... Prop. Line ...................... REPAIR/ADDITION{Prov. Sanitation Permit# ... Date ............. . . Septic Tank (Specify Requirements j Disposal Field (Specify Requirementsj��`�.- � ' "`` ----- f / ..Z�. '4s - (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 Son Joaquin County Ordinances, State laws, and Rules and Regulation$ of the San Joaquin Local Hearth:District, He owner sed agents signature certifies the followings or licen. "I certify that in the performance of the work for which this perm!# Is Issued, I shall not emplo an n as to become subje to Workm ' Compensation laws of California." y Y Pe on in such manner Signed - ---------- - B ---"" Owner other -- Title ...__.. -- - nor! ---------------- (if ............•--• --...... _ FO DEPA TMENT USE ONLY APPLICATION ACCEPTED BY `.-f'..-' 01 BUILDING PERMIT ISSUED __..' .,<_ ----—- - -- ------- -------------------------------- DATE ADDITIONAL COMMENTS X3' 3 -- a .�L- .... 9 ! ................ DATE ---------------- ---- ----- Final Inspection by: _ _ Eft 13 24 1-6!3 Rev. 5H •- . ------------................... -...... _.�.�'.:- •�= 7.. .:�_.. --- SAN JOAQUIN LOCAL HEALTH DISTRICT 8..? 3M