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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT IComptete In TAP11cate) A ► No. �.,7� 3..: ..........•.... This Permit Expires / Year from Date lssuod Date Issued .57�a Application is hereby made to the San Joaquin local Health District for a permit to construct and instal) the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRfSSAOCATION /�0 7 _._.... 0....../)-. . . ..... . . , CENSUS TRA ........ Owner's Name - '' re's. .-.�$' �-j' Phone ,/1 .,� Address !0y _. /� f11'- ��,.��........ ..... - . _.. ..... .. ............ Cityc.�tl.4c /i'' ..,....., Contractor's Name -r.................................................................................lken:d # ... Phone Installation will serve: Residenc *Apartment House❑ Commercial❑Trallw Court 0 Motel❑Other.......................................... f, Number of livingunits:... .. Garbage Grinder' 7 ------ Number of bedrooms _. ag / tot Size x 3 Water Supply: Public System and name ..------. f.. ........ ......................................................Privat®lo, Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam ❑ Q Hardpan❑ Adobe❑ Fitt Materlaf ............ If yes,type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverts 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 Type • ..... Material d[.+.�^ N''` No. Compartments .... Distance to nearest: Well . ............. f,� ` 'J Found tion ... .. ............... Prop. line ...�..........- LEACHING LINE tA No. of Lines ..2-------------------................ Length of each line.__-0--,/......__........ Total length .../.._„ �........... 'D' Box ...... ----- Type Filter Material ....................Depth Filter Material ........................................... Distance to nearest: Well ..../ P_.....�..: Foundation -1742........:.... Property line ....,fid SEEPAGE PIT (ICj Depth cif---......... Diameter M_...... _ Number ...—.2-1 ................. Rock Filled Yes CR No -- Water Table Depth -------->,Z-0--1----------------- ........Rock Size ................................ Distance to nearest: Well ----------------------------------------Foundation ._.......... ....... Prop. Line ................... . REPAIR/ADDITION IPrev. Sanitation Permit# ..................................._._..._.. Date .................................. Septic Tank (Specify Requirements) ..........---........ Disposal Field (Specify Requirements) ----_---•---.....--•--_---- ----------- ------- ------------------------......................................................................................... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work wM be done in accordance with Son Joagule County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin local Health;Distdd. Home ewner or licen- sed agents signature certifies the following: "1 cerci in the perfor ce of the work for which this permit is Issued, I shall not employ any person In such manor as t subject to k s Compensation laws of California." Sig ed -- --- ' .............................................................. Owner By ----- ------ Title _.. (If other than owner) DE RTMENT US_!< ONLY - APPLICATION ACCEPTED BY ------ --- - ---------- DATE _ .S ,a.`... --- ...7._. BUILDING PERMIT ISSUED .:-- ............ .. .......... ...DATE ... - .................... ADDITIONAL COMMENTS ........................ ---------- --------...._.., ..........--.......-................ _... ....... ......................................... Final Inspection by: _ Q. ------- ----------------................. - .... ._................ -- --- ------- Date . 1H 13 2h 1--613 v SA JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M