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rs,+R vr�a.e vacs APPLICATION FOR SANITATION PERMIT ......................................................... 74�— (Complete,in Triplicate! ...--...................••--••-•--•-•......_.. Permit Na. ..................... This Permit Expires 1 Year Frern Date Issued Date Issued .--1,5F:24 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 compliant Ith County Ordinance No. 549 and existing Rules and Regulotionse JOB ADDRESSAOCA ION ,/ r(.-... I . .................................................CENSUS TRACT .......................... Owner's N e .......... ._ .....--- one .................................... ,(kddress d -------- ..- ....... Ci Ph...................... .... . - Gontrador's Name ..._._... - ----- - .... ................................license 71s��3 . Phoney ••_-•-- Installation will serves Residence partment House Commercial❑Trailer Court C 4 Motel ❑Other Number of living units:..... __-., Number of bed ooms .__'..-Gar a e Grinder .-....._.... lot Slate ... _. �a ............. '� LeL! ' Water Supply. Public System and name ••----. - ..� .._...._ ..............._._.............................._.................Private 0 Character of soil to a depth of 3 feet Sand E] Silt C] Clay Q Peat❑ Sandy Loam 0 Clay loam ❑ Hardpan ❑ Adobe Fill Mcterial ............ If yes,type............... ............ !Plot plan, showing sire 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{ ] Size................................................ Liquid Depth ........................ Capacity ...0............... Tyle .................... Material...................... No. Compartments .................... Distance to nearest: Well ..............Foundation ...................... Prop. line LEACHING LINE [ } No. of Lines ........................ Length of each line............................ Total Length .......................... 'D` Box .....'I...... Type Filter' Material ..:...............:.Depth Filter Material ........................................... Distance to(nearest, Well ........................ Foundation ........................ Property line ........................ I SEEPAGE� PIT Q I Depth Diameter ................ Number ............................ Rock Filled Yes C] -No Q Water Table DeOth ----•-••-•.......................................Rock Size ................................ Distance to nearest% Well ........Foundation .................... Prop. line • - ••.w...........•---- REPAIR/ADDITION[Prev. Sanitation Permit# •................................... ....... .Date .................................. Septic Tank (Specify Requirements) ......... .......: ..... •--••.......... .. ............. Dasssosai Field (Specify Requirements} - -•-....... ..... ,C}.`• --_-•-- --.._..-- .............................................. .......... ....................................................... ............. •-� -...._ ..........................................••............. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application.and that the work will be done, M accordance, with Son Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin tocol Health District. Home, owner or licen- sed agents signature certifies the following. "I certify lhrriNtha performance ofithe work for which this permit Is Issued, 1 shall not employ any person in such manner as to beeo{n/914a i o W n's rn e n laws of California." ...... ..... ... .... . .. .........i...... ........................... Owner By .......... .... . ......... // ,, ...............•--••-••.••........ _...lam!/.. .. -- ..-•-------••-•----...... Title .............. ..�............--••-- o er than ownerl i. FOR DEPARTMENT USE O Y y APPLICATION ACCEPTED BY .-.7'. _ DATE ...... . .... ............ '� BUILDING PERMIT ISSUED :............:.................... _.................................DATES-:...................... ADDITIONAL COMMENTS . ......I.......... ............................................. `.....----•.......................................................................... ...... .................................................. ....... .. FinalInspection by: .................... .. G ....-----....... ............Date .. .^.. _.. ,_.-: .------ FEH 13 2L 1-611 �v. 5?•l �- SAN JOAQUIN LOCAL HEALTH DISTRICT 1i 3M I