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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................................................... Permit d I tessue No. (Comptete In Triplicate) - ........ -- �:. ' .. This Permit Expires 1 Year From Date!Issued Da 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-/._. J�f}.�-rl/� CEN$,US TRACT _ JS ?�� Owner's Name ....%710_1V1_.11 ............ ...........................:...:................phone _1..._.. Address ........-/..7hll..... 5 City ...................................... ...........•...... Contractor's Name ------------------------------ ------------_.....---..-------------...----........._.License# ........................ Phone ....... ------ --------_..... Installation will serve: ResidenceVApartment House 0 Commercial❑Traller Court 0 i Motel ❑Other.............. .......................... Number of living units:............ Number of bedrooms .--3.....Garbage Grinder ............ Lot Size ........C..f.............,. ......... 1 Water Supply: Public System and name .- ...----•-----------------------__...........--------_......._.._..._._.................---•----........Private Q Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 E Hardpan❑ Adobe 0 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,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] , ' . 5ize ........ .............. ........................ Liquid Depth ._...........-----•---- /S�//l/GCapaciNC . Type - Material...................... No. Compartments ............... S LEF .._... � Distance. .................................... rop. ne ....__.__._..l. . --------- L( No. of Linesl__.___--_--. Length of e�dt line.,- 7a ... Total Length ._- ...._...._..-_...._. Add0r'D' Box ....../.. Type Filter Material......... )fh .Filter Material .........1`lr. .......................... . Distance to nearest: Well ........................ Foundation ......__-------------- Property Line .-...................... SEEPAGE PIT ( ) Depth . ...... _.__.... Rock Filled Yes [3 No C3 _ ......._.._. Diameter ................ Number .......-•---.-._..._ Water Table Depth ................................................stock Size --•-•-•--...__. ................ Distance to nearest: Well ......._...............................Foundation -------------.-..-.. Prop. Line ............. ........ REPAIR/ADDITION IPrev. Sanitation Permit# _ Date .................. SepticTank ISpecify Requirements) ..........................................• .............................................................................._................. Disposal Field (Specify Requirements) --•------•--•-----------.............................................................................................-............... --- --•- - .. ._------- --- (Draw exis#ing. and required addition on reverse side) 1 hereby certify that 1 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. Horne owner or licen- ses) agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to b su ct to Workman's Compensation laws of California." Signe ---- ----- Owner BY -•--- - ---------------------------•-•---------------------------------------......................... Title _...........----- Of other than owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--Gil. --- . --•----- .............. --•-----------------•--•---_- _-------------- --- DATE . g..r .1:- - ------- BUILDING PERMIT ISSUED ------- .. ..DATE ........................................... ADDITIONAL COMMENTS --------------- ----- ------------------ ------------------------ ------------•----.....------•----•...------•---............................................ -----• •--- ------ ---- ---------------•------•-•-....--.-....-.-.-.-- ..-..----•-......--. ...- - FinalInspection bY: -•----- . .. ................... .-.._.......................... ---------------_-------- EH -.------------ -•- 21a 1-6v• 5M M SAN JO li#N LOCAL HEALTH DISTRICT 8/7h3