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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 26 (Complete in TripNcale) Permit No. ...�6'3 ... This Permit Expires t Year from Dole Issued Date issued .S...yL7.� 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 .... .... v2C ....... ... ................... ... .. .....................CENSUS TRACT ......... ................ Owner's Name ... . .. - ---------- .... f .. ..... CtAddress / Contractor's Name .._ iy o • :... :... ... ......... ... . .................License Installation will serve: ResidenceApartment House t3 Commercial❑Trailer Court fl Motefp Other.........................•••••.............. Number of living units:..-_, .... Number of bedrooms .._.'2,,Garbage Grinder ............ Lot Size .`, ... -dam.............. Water Supply. Public System and name ..Private(� Character of soil to a depth of 3 feet: Sand b Slit❑ Clay Q Peat Q Sandy Loam Q Clay Loam Q Hardpan❑ Adobe/0 Fill Material ............If yes,type............... ............ (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slde.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE M TREATENT ( ] SEPTIC TANKSize..,/ .....�,r¢..�,,............. Liquid Depth .....'rrl...�........ Copacity,/ a ypVQ&5.-C1ZJMaterial- .-- o. Compartments ......Z—:.......Y Distance to nearest: Well .......�f..................Foundation ......,/..©'..... Prop. Line .... .�..0 LEACHING LINE No. of Lines ........./-.....----- Length of each line......../-CV..�....... Total Length .......I.M..' 'D' Box ............ Type Fitter Material � th Fitter Material .11..:'..................� Distance to nearest: Well ....... f.?.�,..... Foundation .......... Property Line .....,.''.............. � SEEPAGE PIT Depth ... 5-...... Diameter ...: .._. Number .........../.......... ... Rock Filled Yes AT No 1:V Water Table Depth / � '4 --•--•• ..............................Rock Size ........... . ............... i. r oDistance to nearest: well ......,1 .G? .f....................Foundation ...... ..._..... Prop. Line ...,. G? ..r REPAIR/ADDITION(Prov. Sanitation Permito ............................................ Date .................................. � Septic Tank (Specify Requirements) ........................._........................................................,....•••-•••..............................................+ Disposal Field (Specify Requirements) ............. . -----------•---- -----------•-- •-----.....----------.-- -----•---•--...-----....----•-----._......................•.........----------...........................-----.................................-- ------------------ ....... ............-............................................................................................ (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or ikon sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, I shalt not employ any person In such manner as to become subject to Workman's Compensation laws of California." oe Signed t- _...._ Owner By .. ----------- R--- �. Title _.. hf other than ovines) - _ ---------- ------- . ......-•------•--- . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - =• ........................................... DATE 7 ........------ BUiLDING PERMIT ISSUED .. _ AT .. ..............................•---...... ADDITIONAL COMMENTS ��/� �'��._... --•----•--• :.._..,._....- G� " C . - -..-. . -- ----•- - - -•• .. . .. . ....... .....:... :. Fina Inspection by: .- •--•-........Date .. `".. EH 13 2!i 1-613 Hev, 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M