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FOR OFFICE USE: TION FOR SANITATION PERMIT ssyy vf, APPLICATION Permit No. z-3. (Complete in Triplicate) _. __ �7, -- Date Issued This Permit Expires 1 Year From Date Issued it to and l the work herein Application is hereby made to the Son compliancern L cwith Countyal Health tOrdinancerict rNo'.549 and existing Rules tand Regulations: described. This,pgplication ism !� Y ... CENSUS TRACT -------------------------- � rr JOB ADDRE S/LO A O - X l-�96----- Phone ---- - Owner's Name ---, --- �] Cit Address __.--.. -i "1-l--- - -------------------- " Contractor s Name _____________" _-- - - License # � _, /�------ Contractor's ----- Phone `. Q Installation will serve: ResidenceApartment House❑ Commercial ❑Trailer Court [1 +U, �•F �, __ _.___-___ ,-. Motet ❑Other -------------------------------------------- o ---- ------- -----------•-- - - a y ' --- Number of livingiunits:----�__.--- Number of bedrooms __�------Garbage Grinder ______"__._'Lot Size ___ .---- ' -----------=-------------=--•-----Private ` ---------------- Water Supply: Public System and name ---------------------------------------- --------------------- Character of soil to a depth of 3 feet: Sand❑ Silt 171 Clay .❑ Peat❑ Sandy Loam ❑` Clay Loam ❑ j Hardpan Adobe Fill Material ----- If If es, type ___ _ Plot plan, showing size;of lot, location of system in relation tolweils, buildings, etc. must be placed on reverse side.] ( p 0 / NEW INSTALLATION:/ (No septi tank or-seepage-pit permittted� eet, if public sewer is available within 200 SEPTIC ., r Size --- ---- Liquid Depth -----,: ------; PACKAGE TREATMENT f ] f l ttType :--=------- Material---------------------- No. Compartments Capacity --------------------- t v3, tiF f Foundation '--------------------- Prop. Line ------------ Distance ,to neare`st: Well __ __ ___ _________ __ Length of esach line---------------------- ------ Total Length ----------------------------- �61rt LEACHING LINE ( ]' No. of Lines ......... "--------- ------------ g 'D' Box ------------ Type f=ilter Material ------ ----------- -Depth Filter Material ----_---------- ' Property Line. -------------------- Distance to nearest:,Well ____-,_____:___,_ ,_ ----..Foundd ion -= --�------;------ p ty Depth _ ' Diameter --------- ----- Number ---------------------- _-___- Rock Filled Yes ❑ No SEEPAGE PIT [ } p ------ ---- - - -- ' Water Table Depth w�`'' t - Rock Size ---------------------------- . , - - t -------- ----Foundation --------------------- Prop. Line --------- ----•------- REPAIR./ADDITION(Prev. Snitation Permit# --------- Date -- `---"---=--• ] Distance t6-negres : e ' I - - r Septic Tank (Specify Requirements) ------------------A------d---------------(l-----------I---__ -- --------------------- �J &� IAAI �f --------------- --------------- ----- --- cif------------------- Disposal Field '(Specify Requirements) ____. �' " ---------------------------------- . __ + ----------------------- (Draw existin and required ad ___-______ . -- ------------------------ - - g q dition on reverse side) I hereby certify that'l have prepared this application and that the work will be done(in-accordance with Son Joaquin County Ordinances, State Laws,-and Rules +and Aeguiations of the JSann Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: k "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------- .._ _ r.----------- ------ Owner -T _ _ —Title t (If oth tan owner) � R A—,NT USE ONLY jj��`']' ---------- r DATE r! ---1 APPLICATION ACCEPTED BY _.___.__ DAT ------------------------------------------ BUILDING ---•------------- -------- ------ BUILDING PERMIT ISSUED _ ______-- ---- -- -- ------- -r-. ------------------------------------- ----•----- - -•- --- --- ---- ADDITIONAL COMMENTS --.----- - --------------------------------------------- --1_ -------- ---------- ------------------------------------------------ --------- ----- ------------ --------- ----- -r;;!- Date -- --- � --- - - -----�- --- ----------------- Finai Inspection bY: � ------- SAN AQUIN LOCAL HEALTH DISTRICT r s I )