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�..��..� V.iLi -_--+..ter,--.—•T^.__. •__ ' ....... . � .. . . .. ........ 1) APPLICATION FOR SANITATION PERMIT .......',�........................... .............. }3 (Complete In Triplicate) Permit . ...... ......................... ............... / This permit Expires.1 Year From tliah Issued Date Issued ................... Application Is hereby made to the San Joaquin Local Health District for a per It. to construct and Install the described. This application Is made In compliance with County Ordinance No 549 and existing Rules and Regulop�tionsmin JOB ADDRESS/LOCATION . �J' v �u1��.. Owner's Nameaz � d �. } CENSUS TR�AGQ"�in ......................... Address " 1 ..............Phone ..:Va�d4� `r��J............... .. . . �, .�......................."I —city .-- Contractor's Name .. ......1. ....... .....................r -• ... ................••---................................................ticen:d nce❑Apartment House=( Phone � Installation will serum Reside Commercial❑T •........... .............................. railer Court ❑ Motel'Ej C1thwj.bA- Number of living units------------- Number af bedrooms ..a�.. -� .Garbs a Grinder Lot Size Water Supply, Public System and name _ .... - ..-- .r-• .. .. ............'. + Character ....................... ...................Private❑ Of soil to a depth of 3 feet, p Sand n Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam 13 Har � . Hardpan Adobe ` © ❑ fill Material............if yes type............... ........... V (Plot plan, showing size of lot, location of system in relation to welts, buildings, etc, must be placed an tons side.! NEW INSTALLATION: . INo :optic tank or see a It seepage p permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT ( ] SEPTIC TANK{ I 1 -aD ................................................ liquid Depth ............................-...... Type .. Material.Q' -S.•..•t,,,. No. Compartments � .. ..`.... Distance to nearest, Well .V&....................Foundation ...� �....- pro 0�..�...� LEACHING LINE [ ] No. of Lines ...9-......... ... i -• p. Llna Ir.......... Length of each line........10 Total Length .I 'D' Box- R .Type filter Material 5�1 �....Depth Filter........ ........ .�-��.......................... p Material r Distance to nearest:_j.WelI;:c.. ::.:..... = fdundation �-- SEEPAGE PIT I } Depth ...... . . """• ••• � erty Lina .... :.......:::;`. ..-�_ .......... Diametar _.. ............ Number ............................ Rock Filled Water Table Depth. ................................................[tock Size ...._. . Yes Q� No [ Distance romares#rWeil ........................................Foundation .................... Prop. Line .. -....`..,-........ 17 REPAIR/ADDITIONiPrev. Sanitation Permit. ... •:; ._ — .- Dt .. .... ................ .] Septic Tank (Speclfy Requirements) •-•--......... 3 c Disposal Field )Specify Requirements) ..............:.....rr......... ...................................... ,,r: .....,...--- _ -...} . .................._............._............... ...........................................................k...... ................•...'.... :...rrr.. .....-......._..:..................... .......r.......................................... .............................. (Draw existing and required add n reverse side) ........................ I :hereby certify that t have prepared this application and-that the work will' done .le. at'Wdence with San Joaquin County Ordinances, State Laws, and Ryles and Regulation's of the San Joaquin Local Health District. Home owner or licen• sed agents signature certifies the following: "I certify that In the performance of the work for which this perridlt is Issued, I shalt not employ any person in such manner crs to Ise me subject to Workman's :Cgr,.3nsation laws of California."Signed ,. :r . By......i..... ...... - ....................... ��. ....owner t .. .............:._......_........ _ rifle .. ............ .......: •(I other than owner) ......---• .................................• FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By. BUILDING PERMIT ISSUED .. ................ ....... DATE ..... .." ..._.........: : ...-- .... ADDITIONAL COMMENTS ........................... ..................................'f..._r Y-. _.. ........... ._......._.._...._....._..... ................... ......... ......__. .................................. ..................................... Final In f. ..................... Inspection by: _.... Date . .. ... ................ ........ ... EH 13 2!, �-fitl Adv. 5�ht .,.......... ..�t?...��a--- -- SAN JQAQUIN OCAL HEALTH DISTRICT 8/7h 3