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MR OFFICE USE: b. APPLICATION FOR SANITATION PLRMIT ` . .... :.......... (Complete In Tdii M) Permit No ��-.� •................................... This Permit Expires 1 Year From Dais Issaed Date issues Application is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulationst JOB ADDRESS/LOCATION ...�..'..©........._.............. ..... � •31. ..� TRACT --.--.--------.-.-----•--- Owner's Name ......A%......�-Ocs1�.'-O.wet_.._.'... -h.............................................: Phone ..--•--•--- Address �.. J .... & City �✓2[��• ...................... Contractor's Namet6�t ,, Lbense Ili .3. 4�`{�`. Phone . � ..1.1--1---::'�.. - --- Instaliattin will w Residence N Apartment Mouse❑ Commercial[3Trailer Court I] Motel❑Other,.�` Number of living units:...e... Number of bedrooms ... ....Garbage Grinder ............ Lot Size ..... ................... Water Supply Public Syste and name_ 1111._ . . ... ""— _ dn_ ..... 1111.._ ......... ............ .Private _ u- ........ .. Character of soil to a depth of 3 foot. Sand W`;- Slit 0 Clay ❑ Peat❑ Sandy Loam❑ Cipy Loom❑ l Hardpan Q Adobe fl f t M,�aterlol ............If yes,type...........' . ............ (Plot plan, showing size of lot, location of system in relation to wells, buiT+�...... etc. must be placed on reverse side.) t NEW INSTALLATION: (No septic tank or seepage pit j sr(nif o if VjVle sewer`,ts available within 200 feet,) PACKAGE TREMM ENT [ ] SERI lC TANK fl � `� ,-�Sizs ,: -.� .... .............. Liquid Depth ., .. ... Capacity ................. Type 1111. idl.._......._.... --- No. Compartments .................. Distanci to arest: Well ----.-01�!.. ; .... .Foundation ....0 `__. .... Prop. Lina ...157 e..... 1111._ .. LEACHING LINE [ j No. of Lines_ ?I-Y............ Length of each line......701_ .......... Total Length %..8�.......... 'D. Box ... 1111 Type Filter Mahal .....Depth'Filter/material . ................... j�► r Distance to nearest; Well ..tet 1.11:1. Foundptl4ts .-_:E✓.. . ............ Property Line .. 1,111. SEEPAGE PIT `.f j Depth Dior ter Number . ......................... Rock Filled Yes ❑ No Q ter. r 1_111.. Water Table Depth .......✓...... .RO&Size Distance to nearest: Well .............. .. ................Foundotlort ....._ —Prop. Line . _--- ..� 1111 ....,,............. REPAIR/ADDITION(Prey. Sanitation Permit# Septic Tank (Specify Requirements) ...... . ........... ... # ................................L ........ )........ ,1111 1111. Disposal Field (Specify Requirements) ............ ......... ... .------- - ..... .....---....----.....-------•--.. . ................. .. ....................................... ..................... ............. .........................._............................................................................................ (Draw existing and required addition on reverse side) I hereby certify that l have prepared this application and that..,l we& will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the S4W Joaquin Local Heokk District. Home owner or licew sed agents signature certifies the following: "I certify thaviy4he perfo nce of ark for which this permit is Issued, 1 shalt not employ any person in such manna► as to become ubject to rkma ' mpensation laws of California." Signed--- //14.. BY ----- -------- ................................... ------- ...... --------- -•-------.............. . .................. ........... ..................... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ------------•......................... ------................................ DATE .....1111 BUILDING PERMIT ISSUED ... 1111. ...---.DATE -.................................. ADDITIONAL COMMENTS ---- - ._.�.ie.......ate..... ... 4' ..els............................. ............... .......I.......... ---- .... :--- -------. .............. . . 1 inaf Inspection by: _.. Date ..... ..::.� �7�r............_. EH - 1111 •--- 1111- --•- 1111_ 1111. .. 13 2!i 1-6f3 llev. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT" 8/7h 3M