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IVx VVrKX Met i ............................................. APPLICATION FOR".°SANITATION PERMIT 'M It:ontpTeh In Triplicate) Permit No. ..... ............... ..0....T .� Thls'PeemltExpires 9 Year From Dahlssued Date Issued .. 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 ADDRESS/LOCATION .d�. ............-�.... ..� ��..........................................CENSUS TRACT .......,.�................ Owner's Name � .. .. .. . .................................... ...................................Phone . :. �� ,�...... Address . .. - .._....�.. ........... ......... . --- . City. -� .... . � � Contractor's Name ---- ----- ----`--- .. ----- ..............................................License # .�, . ...�.�... Phone .. ...�.�.._.,J�..1..._.�J �, Installation will serve: es donee[Apartment House Commercial❑Troller Court ❑ ,. Motel❑Other.......................................... ! Number of living units:............ Number of bedrooms .......Garbage Grinder ............ Lot Size ........................................... . Water Supply: Public System and name ................................._.................... ._......... _..................... ..._................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑. Hardpan❑ Adobe❑ 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 INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) N' PACKAGE TREATMENT C J SEPTIC�� .r-,T e ..,__ Size................................................ Ma#erial.................... No. 1Com Ciquid ompartments ...�........... Capacity/ __-. Yp P r , Distance to nearest: Well ...� .. Foundation ...Prop. Line ............... .4. . LEACHING LINE No. of Lines ------. Le th of each line.... ................C � •-•-----•------•- ng ......_ Total Length ................•--•-`D' Box Type Filter Material . .....Depth Filter Material ...2©......... r Distance to nearest: Well Foundation ......... Property Lime .............. SEEPAGE PIT C Depth .41 . G ........ Diameter 2 !1-' Number ..................... ... Rock Filled Yes ® No ❑ .�, Water Table Depth ---------•--. •--•.............................Rock Size -----........-- .............. Distance to nearest: Well ........................................Foundation __.. ............... Prop. line j REPAIR/ADDITION(Prov. Sanitation Permit# ...................................... Date ..................................I €E' Septic Tank )Specify Requirements) --....... ................. -- .......--•--......--•---................. ...._........_. ..........._............I.•--•- Disposal Field (Specify Requirements) -- - . .r`.., . . ......................................... ------------------------------------••---------.....-•----•.--••----•--------••---.......I..........._......_..._.... _ . (Draw existing and required addition on reverse side) I hereby certify that I nave prepared this application and that the work will be done in accordance with San laaquln County Ordinances, State taws, and Rules and Regulations of the San Joagv:n Local Health District. Home owner or liceR- 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 gampensollon laws of California." Signed ... :...... .. Owner . Sitle ........... ............................. )lf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY (f� ...., DATE ........ �-• BUILDING. PERMIT ISSUED DATE . ..........................•----•-------.................._..._......._._...._..__....... ... .....---........ ...... ADDITIONAL. COMMENTS - .-. ................`..._.....................................................__...I................. 1. ......................................._.....---•--•-•-----....._......-•-------- ------.•-----•--.... .......-.....................----......_................_ _........_.----•----•------............. ...............................•-----...._... ........... Final Inspection by: .....................`X-/--�............................------.................... .......................:... ........_.....Date EH .. _..7. 0. 33 2h 1`6 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M "' - .r0