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:FOR OFFICE USE: APPLICATION POR SANITATION PERMIT ..............•....................:...... d (Complete in Triplicate) .:............:.. .............................. Doh Issued �. ..ti. ..., :Date Issued✓?..Z/ ... This Permit Expires 1 Year From Application is hereby made to the SanJoa in Local Health District for a permit to construtt and Install the work herein described. this opplica#ion is made in co iance with County Ordinance No. 549 and existing Rules and Regulations:. 'JOB ADDRESS/LOCATION .� l �... ... �.. ........... .......................CEN5l1S TRACT / Owner's Name .._ � `.. .. . ...... ,.�-P..._..: . ..Phone .. Address ._.....: __........ .............................City ...................'. ... �t act r' Name c 1.. .......S�_�n::.. ..License # ....... ............. Phone ' 6 6 a�6a.7....... : Cali r o s . .. ........................ .. . Installation will.serve: Residence It Apartment House I-] Commercial(3Trailer Court [3 Motel❑Other Number of living units:.........:. Number of bedrooms ....3...Garbage Grinder ............ Lot Size r y ; Waiter Supply: Public S stem and.Ham`s........:.......... ............._............:.:.....................................-............:.......Prirrcite Character of soil to a depth of 3 feetf-- Sand 0 Silt[3 pay 0 Peat QSandy LOCI Q Clay Loam� Hardpan f3 Adobe] Fill material ............If year type.............................. (Plat plan, showing size of lot, location of system in fetation 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 13 SEPTIC TANK q B Size... :��4,.i�: �.:�....................... Liquid Doo:............................... Capacity .�2 p??....... Type !: C4... .. Material : -`....... ;Ma. Comparfrr+etKs .,..Z..... . 0. . 'i Distance.to nearest: Well .... ...............Foundation Prop. Late ....: .....-..:6': LEACHING LINE , No. of Lines ......;21...... ng Leth of � -each find.....a. ......... . ~,Total. h ngtf /7D• ............... 'D' Box . Type Filter Material � .Depth .Filter Materlal ff ..... ......... . ' �. . Fcuhdation _.... �...... Property .. .............. Distance to nearest: Well .. .. .. . SEEPAGE PiT �JQ Depth ......... Diameter 's ' Number ........ .::.:1 Rim* Filled ' Yes (9 No 0 . .«...�._� Water Table Depth _... ..................................Rodk Sire .......�.�? .�..3��.. - Distance to nearest: Well ... ........... .............Foundation' . .. : Prop. ;tine ....... �.......f i REPAIR/ADDITION(Prev. Sanitation Permit# ............................................... ..... .................... .} Septic Tank (Specify Requirements)....:..................... .... ..... ....._.............. Disposal Field L(Specify Requirements) ................................................ .................................................................I..................... )Draw existing and required ciddition on.reverse side) `{ I hereby certify that I have prepared this application and that the work will be done In accordance with Sun oat J {01ltt County Ordinances, State Laws, and Rules and Regulations of the 'San Joaquln Local Heal&'District. Home owner or licen- sed agents signature certifies the following: "I'tertify that in the performance of the work for which this permitr is issued, i.shall not employ any person In such manner as to b me subject Workman's Cam ensatien laws of California." Signed ...... ...... ............ ......... Owner ! "- Title _.. (if other than owner) ' FOR DEPARTMENT .use ONLY APPLICATION ACCEPTED BY . - - ---------------------------------'-----•----•-_-.------._.___..__.... DATE :,,,, .. .-�'.-�E.. •...__._... BUILDING PERMIT ISSUED'__---------- -----------DATE ......................... ADDITIONAL COMMENTS ..__.... --,'----- ................................----------------............................ .................. .,............ ......- .._E __________________________•____ __.___ .• -• •-•- ........... • • ••..___ __.__... .....____.._.__-_.....__...___.._.__-....... ........... .._._.._... .____....._.... ___. ... - _._.....__ /f _ -___.....-..._-. i Final inspection l,y: ................... } ' El-1 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7a 3M