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FOR OFFICE USE: .................................. ............... APPLICATION FOR SANITATION PERMIT Permit No. (complete in Triplicate) ?`' 7 ...-•....... ....................... This Pertnit Expires 11 Year From Dais issued 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 ........ fT7.t.ti�ty....11a1�....................CENSUS TRACT ..._......_..>............ i Owner's Name4 _ � ' Phone �' Address ..._ .�(��Cin . ' .. 1'.. ��.•.. � _ •- - City _:7"n5,4 _.- bl� - �4 Contractor's Name -------------1:5.1-1 . License # --------- -------------- Phone ..----_.__..-_- Installation will serve: Residence 0 Apartment House Commercial oTrailer Court � Motel (]Other -------- ----------- .............. E Number of living units:__•- . Number of bedrooms. ........Garbage Grinder -#Q-,---- Lot Size .------------- ..` -v• Water Supply: Public System and name .............. --------- ---- ---.....-•-- ---------•---•--------._--------------•-•--------- ----- ..........Private Character of soil to a depth of 3 feet: Sand 0 _Silt(] , Gay ,❑ peat Q Sandy Loam 0 Clay Loom JS Hardpan ❑ Adobe t=ill Material . �F... _ _ _. l_7 _:.....- ... 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: lNo septic Tank or seepage }sit permitted if public-sewer.is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK liquid Depth ................... . ] Size. •-•----• _..... . S CapocitylA�a..aAt- Type -------------------- MaterialCx`.v..e.4r-- No. Compartments ............. Distance to nearest: Well --_sC .�_.. T ..._--E......Foundation Jjg?__�Ft - a Prop. line .. LEACHING LINE { ] Na. of lines -.---•----•------ Length of each line.-----9..P.... : ......I Total Length ..a 2.e.....f ...... 'D' Box __---f...... Type Filter Material :Rods:...:...Depth .Filter Material ._..!__.<....�-••_ ' Distance to nearest: Well .. �a4... :.: Foundation . - �''t'•. Property Line...a:Z2 .._- ... SEEPAGE PIT { j Depth ..__.-- Diameter ............ .......................... Rack Filled Yes ❑ No iC] Water Table Depth .............................. . Rack Size -t-_ _........................... (� Distance to nearest: Well .----_-- Foundation Prop. Line ..-•.•--•-•-- F REPAIR/ADDITION(Prey. Sanitation Permit# ---:•---.------------------••-•-------- Date .............'_. Septic Tank (Specify Requirements) ........................................................... Disposal Field (Specify Requirements) ------- _---_--- -------------------------------------•-••-•----------• ------------..._.---•-- 2-- --------------•----- ------------------••---------------••-•--------------......---••-------... (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 Som Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sc_ Joaquin Local Health District: Home owner or (leen- sed agents signature certifies the following: "I certify that in theerformance of the e work for which this permit is issued, .1 :hall not employ any person in such.manner as to becorn subject to We a Compensation laws of California." Signed ...... ------- Owner -------•- ey -- -- ----------------------------------------------- ••------- title -------- ----------- other Than owner) FOR DEPARTMENT USE ONLY APPLICATION'ACCEPTED BY _ . - 7�. ---<-- - -----:-•--------------------- ------ DATE ...�.:,�� BUILDING PERMIT ISSUED :_....___'.......... . .. .. .'._ - ------ ---DATE ................•----•. DDITlONAL COMMENTS __..._..._.. ------- ADDITIONAL ------ ------------------ ----- -------------•---- ------ ...__ .........- Fina Inspection by: -- ._ Date . .. Eli 1.3 2!� 1-6Fi Rev. - - � �................ SAN JOAQUiN LOCAL HEALTH DISTRICT 8/7& 3M