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vrrR.s vas APPLICATION FOR SANITATION PERMIT '... . -................I •' f � Permit No. ..................... .-.y �t (Complete In Triplltate) , Date Issued This Permit Expires 1 Year From 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. A49 and existing Rules and Regulations J-.� .....••---•.. - ADDRESSAOCA N ........ CENSUS TRACT .......................... . Owner's Name •.. .................. .-----•-•......._.........--•......Phone .................................... Address .................J.7 .. _ ---- ---•-• -. -•----................City ----.............. _...•••-- --------------- ---................ Contractor's Name . ......... .................................License #42 Phone!T �F.-e?4 6.. Installation will serveh Residence jg Apartment House❑ Commercial OTroiler Court 0 Motel ❑Other Number of living unit$•.... Number of bedrooms Garbage Grinder Lot Size � Water Supply: Public System and name ......................................---------------------........_..........................................Private Character of soil to a depth of 3 feet: Sand O Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ 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 sept€c tank or seepage pit permitted if public sewer is available within 200 feet,) J i �,/ /! PACKAGE TREATMENT [ ] SEPTIC.TAMC[�" � S€ze.1��_4l`J . ......... Liquid Depth � Capacity 14-0.0....... Typet/oze:(� Material_ ...... No. Compartments ......P. ......5 ' Distance To nearest: Well ,.10.40r._.. . . ._Foundation ..�� ..... Prop. Line .....�� i -EACH€NG LINE [� No. of Lines _......2.......... Length of ea hne. .f,�. �.. ... Total length .�, .�........� 'D' Box .... Type Filter Material .� 4e.Depth filter Material .... ./4&. ............ ...... fi Distance to nearest, Well ,�� _ foundation ....... Property Line .............0 SEEPAGE PIT [&r' Depth . ......... Diameter ......... Number .......4;2 ............ Rock Filled Yes W No CP' 4 (Nater Table Delath .,/ZO................................. ,.Rock Size Distance to nearest: Well ...../a ......................Foundation ..l.0-d....... Prop. Line -:3Q...._..._. REPAIR/ADDITION(Prov. Sanitation Permit# I ..........-•----•........................... .Data ................................ SepticTank (Specify Requirements) ........................... ......................................,....................... ..... ................ D+soosal Field (Specify Requ€rementsj ..........�._....�-........,__ ..... .' ......................................................................... .................... .............•............................................_--........................................... .....................I....... (Draw existing iInd required addition on reverse slde) t . t I hereby certify that I have prepared this application and that the work will be done In accordance with San Joagvin County Ordinances, State Laws, and Rules and Regulatlons of the San Joaqu6 Aocal Health District. Home owner w licen. sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, I shall not employ any person In such manner as to becom object to W kman' Compensation laws of_Csalifornia :z.cJnec' ........ _. �........................................ Owner By ................... . .._lff ............ ---• --•------•--... . ...`....` fj...-..................................................... (If other than owner) O PARTMENT USE ONLY APPLICATION ACCEPTED BY :.... DATE ..........:: BUILDING PERMIT ISSUED -- ..... DATE=.:......................................... ADDITIONAL COMMENTS ... . . -- ------- ---•----•----•----------------- ....................... ........... ..................................................... . .. ....._ ......................... --........-•--•.........................................._................................. .............. I Final Inspection bY.Y = :. Date .-. .- 6............... ._.�.._`........'....y.. . ..' ...; . E 113 2 1-•6Fl SA JOAQUIN LOCAL.'HEALTH DISTRICT 6/7h 3M