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FOR OFFICE USE, . l e:3 �s¢. 9-r t 7 s� APPLICATION FOR SANITATION PERMIT .ICompleta In Triplicatel w Permit No. :. :�... 7At ...... . � ....... . . ... This PermitiExpires 1 Year From Daft Issued Date issued .__� -.S' 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 Regulations: / JOB ADDRESSLOCATION . L.. � .......................CENSUS TACT ..................... Owner's Name ....... .....:......... .:.. .........Phone ......_.... ........................ Address ._ '1� ....... r�'.. ,,'j ! �r 17...-... ..........City 51.E ...................... Contractor's Name ..... � .:"',err > ..................... .....License# f xf., Phone :. .... Installation will serve. Residence Apartment House fl Commercial OTrailer Court Motel ❑Other ......................................• Number of living units:.../.- Number of biedrooms ..:...Garbage Grinder .te-,-F— lot Size Water Supply. Public System and name ......... ..... ......_............... .... .:..... .. .....____...__._.:..-...Private Character-of soil to a depth7of S feet: Sand I3 Silt Q Gay 0 Peat 0•.. Sandy Loam Q Clay Loam Hardpan o Adobe o Fill Material ............if yes,type............... ...........:, (Plot plan, showing size of lot, location of system in relation to wells; buildings, etc. must be placed on reverse side,) NEW INSTALLATIONi .IN* septic tank or seepage pit permitted if public sewer is gvailable�Within 200 feet,} PACKAGE TREATMENT .[ ] SEPTIC TANKd �. ��-�, � ��:�.�s�� . Liquid Depth ',.............. L� Capacity/_-l�xe.::=:--Type ... Materla1 11 .. ..... No. Compartments .;?�' Distance.to nearest: Well .- ......: ...........::.-Foundation/"�..f........... Prop. Line LEACHING LINE No. of Lines ...... ............... Length of each line---F :...::.:::.... Total 'Length ./1-740............. 'D' Boleto ... Type Filter Materiaoo--66 Depth filter Material ..............:..:.. .. F �.. Distan nearest, We ... ......... ry. Foundation ....fes............. Property Line SEEPAGE PIT p of De th a��..._ ...... Diameter .. ........,'iVurxtber ..... ...................... Rock Filled Yes.,t No .... ..,... Water Table Depth ......1-->129.......—7.......................Rock Sizw./. ' �................... Distance to nearest: Well ._. '..7`�.................Foundation ../K:f..._.__= Prop. Line��..p....... ..�° REPAIR ADDITION Prev. Sanitation Perm / # it+i#t ....... .. ........ Date ...... ....................... -! Septic Tank (Specify Requirements) . ..................... .......... .................... ,............,._. ......:... Disposal Field #Specify IZequirerrtents} • ------•-••......... .:.:..... ......:. •-•---..._•--•--•-- -••--- ---•--- ............................:......:_.....___ .................------------------ --------- ---- .... - •.................. .. . ...................................... . ---------------- -----------------------.:..--------- ---------•---•-•-•----•--- ----- _.: ................... -•-----: ......__......._..--•-•--;...-•---..:-.... (Draw existing and required addition on reverse side} I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Jertq n- Al County Ordinances, State Laws, and Rules and Regulations of the San Joagnln Local HeaII&District. Home owner or lieett- 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 subject to Workman's Compensation laws of California", Signed ----- -----•- -- ------ - --------------------- -----------•. Owner BY _._.... Title : . her than owner) R DEPARTMENT USE' ONLY k APPLICATION ACCEPTED BY ----- DATE _. -x:75 ,. _.:...._.....:,.: BUILDING PERMIT ISSUED ..- , DATE ADDITIONAL COMMENTS ------- S f_..._.. ..--- .............- _-- d -.-_--_. ---------------11----------------------- --------------- --------------`----•1•------- - -------- ------•....... ....... Z. ti Final Inspection by: --------- '.._.:--.-' `_.... •.................Da - _.............. te 13 .2h -6t3Rev. 5mSAN JOAQUi OCAI HEALTH DISTRICT 3M