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fUK OFFICE USE: e APPLICATION FOR SANITATION PERMIT ... ..--- -• 'f 11 iCanplete In Tri iicafe a Permit No: .�`5 -•-.... ............... .--• This Permit Expires 1 Yebr From Date-Issued _ , 9. Date Issued Application is hereby made.to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This applicationFis made in compliance with County Ordinance N549 and existing Rules and Regulationst 1 ,. o. JOB ADDRESS/LOCATIO ...��. .............................CENSUS TRACT .......................t.... Owner's Nome ....... .. Phone IL ' Address _..---- ` - flL4.�........__. ,. ....-- -- ...... City ...... � _ Contractor's Name ..............11--- ..__._..License # ., _ Phone ....... ........ tS�Fo7.--- Installation will serve: Residenco KApartment House 0-Commercial QTrailer Court Q F Motel[`J ..................................... Other - Number of living units:... Number of bedrooms`?:5- `Garbage Grinder:.� of Size X Water Supply: Public System name = :. Private Character of soil to a depth of 3 feet:. Sand Q Silt❑ Cloy,•1E. Peflf❑ Sandy Loam fl Clay Loam.Q Hardpan Q Adobe l=1l[Material . .......... if yes,type (Plot plan, showing size of.�lot, location�of system in relation to 1.11 wells, buildings, etc. must be. placed on reverse side.) NEW INSTALLATION:. "kj /.. I (No,septic.tank`or seepage-pit permitted if public sewer is available within 200 feet;) PACKAGE TREATMENT I ] : ,SEPTIC SEPTIC TANK )' Size.:::....:.......: ..---...... LiquidDepth ........... _ I ' Capacity ...::: .. -- Type ...... Material....................... No. 'Compartments Dis4an16e::5to)nearest: Well .............:.......................Foundation .........I..... i.: P _ :y rap. Line . r LEACHING LINE No. ;of Lines._.__:...._ ,.._..... ::,0 ( 1 .Length .o#, each line.........:... _....... To ------• tel�Length � , `D' Bax .. Type Filter.Material ....Depth filter Material Distance to nearest: Wel! ; A t! :....... `.... Foundation ... ....... Property Line ........................V SEEPAGE PIT { ) Depth ` Diameter _................ Number ., _............_:..---• ......------•..._.... Rock Filled Yes Q No Q� a Water Tab]e ,Depth`,._:1.....................F ----••----••-----•-.Rock Size .......................... Distance to a est:-Weil` ----..:: Foundation ...... Prop. Line .................... +� � d�. ... REPAIR/ADDITION(Prey. Sanitation Permit# . Date ............ Septic>Tank (Specify Requirements) .............. :: Disposal Field Specify Requirements) _••,----- — c.s•C� • 4 -----••------- k�l� �; . —�...._.�, _v _ 1 r i -._._.... :.... ••-•-• .... .. ......... •--•-------•• ---- I - ............ ....... Draw existing and required addition on reverse side) . I hereby certify that I have re are this application and that the work will be. done in accordance. with San Joaquin County Ord inances„State Laws, and Rules and Regulations of the San Joaquin Local Health district. Home owner or licen. sed agents signature certifies the foliowing: "I certify that in the performance of the work for which this permit is issued, t shall not employ ' p y an y person in such manner as to become subiect to Workman's Compensation laws of California.” Signed M g .. Owner ^.-- .,.F ..� BY ` ...... Title .................... - w (If r than owner) ••--------•-• . :C3�t LDEPAR. ENT•USE ONLY APPLICATION ACCEPTED BY ��._ .-- --...-- . .... . .-----.................... DATE ..�..-�:.7.-:.`I_�............ BUILDING PERMIT ISSUED ._ :10.._..__ . -•------- .DATE ........._................................. ADDITIONAL COMMENTS _ . ._.•,--- ............ ..... ........ ...... • ..................... ...... ........__...... .... ---••----..._...---- • •.........................•--.........._._...__.... . ............I......... Final Inspection by: .._ .............................................................•----•--...Date'.�� `�j �......... r i �' SAN JOAQUIN LOCAL HEALTH DISTRICT t-i-L13 24 %-,Aa