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Fti.iK Yit'F'Y� Yiryt.'t " APPLICATION FOR SANITATION PERMIT 7 ........................................................ 1Comgtete In Trlpttcahl Permit Na. ...7 Z. �•--------- . .. ............................................... This Permit Expires 1 Year From Date Issued Date lasued :, d :..7.7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work hweirl i described. This application is rrmade In compliance with County Ordinance No. 549 and existing Rules and Regulatlonsr JOB ADDRESS/LOCATI Pell.71, ....::- ....................................CENSUS TRACT ....... Owner's Name .../re .............................................................................•.............phone `G q 1........ Address ---• .........................City .. _._ -• ........ •------ --�= Contractor's Name //sJ y ,.... .._._-....License# . ...=...��.�� Phone --. -��. . Installation will serve: Ras once PO*artment House❑ Commercial❑Troller Court (3 r Motel❑Other............................................ Number of living units:------------ Number of bedrooms .......Garbage Grinder ............ Lot Size ....----------------------. � Water Supply: Public System and name ........................................................._.................................................Private Character of toil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam [3 Hardpan❑ Adobe❑ Fill Material ............If yes,type............... ............ r�- - W {Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverts slde.�Al NEIN INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,{ i PACKAGE TREATMENT [ 3 SEPTIC TANK /�_�Siz�e... ... Liquid Depth . � Capacity/!l.A.4.4—gyps ---"�`��Materlal..................... No. Compartments ... ..........» i 'Distance to nearest: Well 1 .Foundation le............... Piop. Une Sj LEACHING LINE [ j No. of Lines -------------------- Length ofyyeach�� line...7e....._...._........ Total Length �.�..--•---....,_...� 'D' Box J....... Type Filter Material ../ ....Depth Filter Material . ................................. • , Distance to nearest: Well ........................ Foundation ........................ Property Line ............... .. SEEPAGE PIT { ] Depth .................:.. Diameter ................ Number ............................ Rock Filled Yes ❑ No Q Water Table Depth ................................................Rock Size -•----... ................ Distance to nearest, Well ..--.....Foundation ....... Prop.•Un* : .................. REPAIR/ADDITION(Prev. Sanitation Permit ............................................ Date ..................................{ SepticTank {Specify Requirements) ......L.. .................•--..... . --...-•---...............--••-------------•-----............_. .......I...,................ ' Disposal Field (Specify Requirements) ---•-------•--••--•.............•------•••................_....--•----•••.........••---....................._......................._.........._...._..--------•'--...._._...._.........._............... (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 accordance with Sao Joagala County Ordinances. State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horse owner or Been• sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued. I shall net employ any person In such manner g to Workman's Compensation laws of California." Illli Signed red eco�su ect to War ..... ............ ..................... .•- •---...........-•----_.. ..-_._.. Owner - . title --------------------- ---------- .........,...._----- {If other than owner) FOR DEPARTME # USI: ONLY APPLICATION ACCEPTED BY DATE .... BUILDING PERMIT ISSUED ........................................... .....DATE -.._......--....--------................... --••----.....--•--•............._---------------.._. ADDITIONALCOMMENTS ................. -- -- - -----------•........••--- --------.....••----••---........._.............-------•---------------- ------......_... ..................................... ..... .........._.............................................:..................................................._...- ........................................ ........................ .... .............. .--..---•-----.. . Final Inspection by: ............... .....................................Date ........: ._�: 2�.-..-7._7EH ._. 13 2h 1-613 Rev. [ SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7ti 3M I f -