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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT ... ...........:....................................... Permit No. .7.7: �.3 (Complete in Triplicate) . ... .... ........................... _ n --Do - te Issued .. . ... .. This Permit Expires I Year From Date Issued .... .. .... .... ........................... __ Application is•hereby made two the S-"dn Joaquin-,Ldcol~Heait'h Dlstria—fok 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 Rebulationsi ,108 ADDRi:55%LOCATIONi -.._.._... .......................CENSUS TRACT 2� Owner': Name ........ ....•..................... ...............................................Phone ..... a 4 Address .�-7- 2 - = = i ....._..City ....." ~ .. ........_ . ......w .. 'Contractor's Name _•• =6c� .....................License one Installation will serve: p?'Repartment House[] Commercial❑Tra urt Motel ❑Others................. - --------:---------- Number-of living units:............ Number of bedrooms Garbs a Grinder Lot Size . Water Supplys.Public System and name........................................................ ........_...................................-- —Private Character of sail to_a depth of 3 feet: Sand'❑ SiltEl Clay.❑ Peat❑ Sandy Loam C) Clay Loam:0 ; Hardpan 0 Adobe❑ Fill Material ............If yes,type:............ ........... i (Plot pian, :!ihowing size of lot,Jocat16�bf-.system to relation to wells, buildings,.etc. must be placed on reverse side.) NEW INSTALI.ATWAi 4 (No septic tank or seepage pit permitted if public sewer is available within 200.feet,) PACKAGE TREATMENT [ ] SEPTIC TANK, Size ............................................... Liquid Depth -'.....:_......_ ...... Capacity .._. ype ..r oterlal..... No. Compartments ----.... •--- •f Distance to nearest: Well C�__ ..Foundation! .. Prop. Lina . F E _ ..._..- Total Length G. ......--........ LEACHING LINE-)[-]-,No of Lines � ................ Length of each line../ t?i 'D Bo '' . ..a rTypeFilter Material __ .Depth Filter Material .dam.. .............................. • Distance to nearest: Weil Foundation Property line ' 's -- -------=------- ......_..----......... ..................,..J SEEPAGE PIT { ) Depth .................... Diameter ........ :"Number ........-__ .__..........._ Rock Filled Yes ❑ Na ' Water Table Depth ............................Rock 5iza=-..- ......-_....... ._. F i Distance to nearest: Well ........................................Foundation ........... ........ Prop. Line ....... REPAIR/ADDiTiON(Prev. Sanitation Permit --•--•......... .....---�----------•-•-•.................... Date ...._....... . # O Septic Tank (Specify Requirements) ..................... ........ .----••--._............... ........._....................... ................... s. •3 f Disposal Field (Specify Requirements) .............:...................................................................... --:_...... ........... --------'- r ............................................ •-------...... ................................•..............-......................................-__ .................. - (Draw existing and required addition on reverse side) I` I hereby certify that-I have prepared this applicatlon and that, the work,will be done in accordance with Sent JaaelwM f� County Ordinances, State Laws, and Rules and Regulations of the Sato Joaquin Local. Health District. Horne owner or Been• sed agents signature certifies the following: certify!that in the performance of the work for which this permit is issued, I shall not employ any peraen In such manner las to b!e=A subject to_Workman's ompensalion laws of California." I Signed .:Owner By .......--t........................ .............................. Jitle ..._.....__".._..__...........................:.._............._.. ..... (if other than owner) s R DEP RTME T YSE ONLY i APPLICATION ACCEPTED 8Y...... ... HATE ...... 44 BUILDING PERMIT ISSUED ....................... .......................................................... ....................DATE .......,..............._................. .. ADDITIONALCOMMENTS ....................................... ........................................ ................... .................................................—.........--...........................:.._V.- •........................................ ................................................-----..... ................... . ........ _ .. .....................------ ..................� .... l�I 13 2�Final Inspection 1-611... Rov. .. ....'...RtCT.............Date .... ....... 8/7h SAN JOAQUIN LOCAL HEALTH DST �7& 3M