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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT z.................. ------• ------•--....... ICompiete In TripiicatolPermit No. :..:............:. ....................................... . -- # - Hate Issued ......../. 7� This Permitfxpires f,Yearfrorn DatMlssued Application is hereby made to the Son 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. . .Y34.. __r�4F/. CENSUS TRACT .......... Owner's Name --------------- --- -•• Q -��-3 ----. ... ............ ...... ........... ..... ....Phone -- -. �._._....��......-_. Address ............ Contractor's G Contractor's Name ----- ........ ..._............. ....................License # ... Phone Y6....:7?0a7-- Installation will serve: Residence J%Apartment House fj Commercial❑Trailer Court. ❑ Motel ❑Other i Number of tieing units':... Number of bedrooms ---_5--_.Garbage Grinder Lot Size ...1 �............... xx • Water Supply: Public System and name _....Private [] Character of soil to a depth of 3 feet: Sand❑ Silt❑J ' by�Q Peat❑ Sandy Loom fl. Clay Loam ❑ t Hardpan❑ JAdobe Fill.Material If yes,type (Plot plan, showing size of lot, location of system In relation t ells, buiid€ngs, ,e, tc.-muO be placed on reverse side.) ` NEVA INSTALLATION; (No septic�.tan#e"or seepage pit permitted If<public, sewer Is-available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size...!... ........ .............................. Liquid Depth ..................... Capacity .................. Typle .-----•-?".:_......JMa er alt...... _' _ No. Compartments ` r t Distance to nearest: Well Prop. LEACHING LINE [ ] dNo. of Lines ..............., .+,Length of each ling .gerI. ; t ,n.i...... ::.-.1:`Total Length ...... •................ 'D' Box ...........I Type filter Material .---•-.,_. ..-....!Depth Filter Ma er€al ............................................ t p Distance�4bo nearest: Well .................. Foundation .. Property Line SEEPAGE..` PIT ( 1 )epth ----=--------•-•---• :Diameter .....-••-- ---. Number _....:........:............. Rock Filled Yes ❑ No �] -. i Water Table Depth ---------=-----------Rock Size ...... ............. .-------._._ Distance to nearest: Well . .................•...................Foundation .------I——..... Prop. Line -__...._.............. REPAIR/ADDITION IPrev.,Sanitation Permit Date ...........:.•--- Septic Tank {Specify Requirements) _._:... _ __ � .A ._ :1 -ri if�`�.�_'. -- -- ••. -•---.. Disposal Field (Speci�----Requirements)............................................... -- �--•--------------------•-•�---------•---••--•--....------------...-------------- .. ----------------------------- -- • ••-----•-•-••----•...I._.. ............ .. . ...•----•------•-............... ---- •-------- ------------ I .1 -----•---••-------._.......--•---•-------------- --- ------------------------------------------ -- ------------- (Draw existing and required addition on.reverse side[ . . ! .hereby certify that I have prepare .this appilcation and that the work will be done In accordance with San Joaquin County Ordinances, Stais LawsXand R0e's and.Regulations of the San Joaquin Local Health,District. Home owner or licew sed agents signature certifies the following: "I certify that in the performance of the work folwhich this permit is Issued, 1 shall not employ any person In such manner as to become subject tolWorkman's Compensation laws of California." Signed ..... •---- ...... ............... Owner --- BYr ... ----------- Title ...... ....... ..f.._...-----.... --......----•--•-••-•------- ------ llf othe han owner) - FOR DEPAJtTMENT USE ONLY APPLICATION ACCEPTED BY DATE BUILDING 7 3^ BUILDING PERMIT ISSUED ------f•--- ---i {, -----------:.-DATE ... --•• ADDITIONAL COMMENTS ..__..- ....... .• '-••--••.._: ... --._...f ....:... ............. -•------....---....-- ----------••--•--.:..-- ------------- ---- . .... .......... .. ........................................................ ---• ------------------- ---- ----------- ........ Final Inspection by: ................ ........... Date ..�..' �'...7_ .........-••-... _ ... ---•---•------•-••--- ----•• -- . ................... 13 21� 1-6v• SAN JOAQUIN LOCAL ACTH DISTRICT 8/711 3M