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FOR OFFICE USE: 11 1 APPLICATION FOR SANITATION PERMIT .................................................... I� (Complete to Triplicate) Permit W. � rl" ......................................................... _ ,y? Date Issued 1:.. T' i This Permit Expires I Year From bete Issued 60 ? //V 2— Application Application Is hereby madel,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. 549 and existingles nd Regulations, JOB ADORE55/LOCAT �. ''� . . .�,�CJ.,. [ 5 S CT Owners Name ff .............. ................ ............... .. Phone ._ 0.. #r! ,r- Address ........ .......... ................ .................. City ... .... ..................................... Contractor's Name ...............�N .!Q' .. ..........................................License tP ....... , ............. Phone .............................. Installation will serve, Residence XportmeM House Commercial OTraller Court 0 Motel ❑Other............................................ Number of living units,......1.... Number of bedrooms ...Garbage Grinder ............ Lot Sire . %. ... Water Supply: Public Systerii and name ..........................................................................................................Prhrah 3, Character of soll to a depth.ice 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam❑ If Hardpan Adobe�' Fill Mdrerlal - yes,type . �} ..........:: s (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse :ida e NEW INSTALLATIONS (No septic tank or seepage pit permitted Ifppub is sewer 19,0vollobt within 200 feet,) i PACKAGE TREATMENT [ .� SEPTIC TAN Size Liquid Depth .......................... a !� p ,� Capacity / Type ..... Material. ��........ No. Compartments .. I / _.T ' Distance to no rest: Wel!' .........a. ................•Foundation . ............. Prop. Line ---c - -----. LEACHING-LINE No-of Lin ...... .._.._.. Length o Aou%ation ne..... ... Total Eengt ... - � 'D'IhBox ....-.1..... Type Filter Materi4.. Depth alter Material ......... .. •• Distance to nearest: Well . . � AA Pro Line :� ..... party ..... .No..... SEEPAGE PIT Depth ... :.. Diameter ......... Number ..... .... Rock Filled Yes C Water Table Depth _._..... ............Rock Size ........ .r� 40 Distance to nearest: Well .......... ............Foundation . . ..... Prop. Line ................ REPAIR/ADDITION(Prov. Sanitation Permit 0 ............................................ Date ................... ............. SepticTank (Specify Requirements( .......'.......................•.......... ............ .........•......... ......................................-................ ` Disposal Field (Specify Requirements) .......................................................................................................... ................... :. . .................................°I�..-----•-----...-..........--•_................._....... ................._..............................-...........__._-.......................... ...... i 1M - --•- ............... .... ................................................................. 1 (Draw existing and required addition on reverse side! I hereby certify that I have prepared this application and that the work will be done In aceardance with San Joaguln County Ordinances, Slat* Laws, and Rules and Regulations of the Son Joaquin Local Health District, Home owner or licen• sed agents signature certifier the following: "I certify that in tics. Performance of the work for which this permit is issued,.I shalt not employ-any person In such manner as to become act ;*rWo rkrnon's Com ensation laws of California" Signed [ .... Owner By ..... ...................... ......... Title (If other than'lowned �. FOR DEPARTMENT USE ONLY ° 'APPLICATION ACCEPTED BY ............. DATE � �0.......:............. BUILDINGPERMIT ISSUED ':.......................... ............................................................................DATE>-....-...........-------............-...... r ADDITIONAL COMMENTS ... ... •..................•-•• i i ... ........... I: 91 i Final inspection by: ..... .. .Date Y.d ............ ............... EH 13 2h 1`60 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M ! J