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F i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........................ Permit No:� ..__.. .l_... (Complete in Triplicate) ......_.............. . . Date Issued .��. .. .:. � t This Permit Expires 1 Year From Date Issued � Application is hereby made to the Son Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing_Rules and Regulations: I JOB ADDRESS/LOCATION --•••" -� '-1� S 5 TRACT .......................... 1 � �_- _ _.._._Phone !� ........ Owner's�Name ....... Address / rS'1�..._....'.._..._._. City _._. Contractor's Name ....1:V0. .......License # •. ---:............... Phone ........ ...•................... Installation will serve: Residence:00 Apartment House❑ Commercial QTrctiler Court ] Motel ❑Other .............................................. Number of living units ............. Number of bedrooms ----------..Garbage Grinder .............Lot Size ......................:...:.. ..••... ......:...... ......Pri ---•..............................•--• - . _....,. vats ❑ Water Supply: public System and Warne.,,__..,.---..-.- � �- Character of soli to a depth of 3 feet: Sand n Silt❑ Clay E] Peat❑ Sandy Loam fl Clay Loam n Hardpan ❑ Adobe-M Fill Material ............ if yes,type ---------------------------- (Plot plan, showing size of lot, location .of system in relation to wells, buildings, etc. must be placed on .reverse side.) NEW INSTALLATION: (No septic to or seepage pit permitted_if public sewer is available within 200 feet,) k Size. ----• Liquid Depth ...... --•.......----••-••.F 4 PACKAGE TREATMENT [ ] SEPTIC TAMC'[ ] ••• •----••..... Capacity ................Type Material...................... No. Compartments ............ Distance tol nearest: Well -..........Foundation Prop. Line :...::.....:.......:. 4 Length of each line.. Total Length ........_........--•----- No. of Lines ••- g LEACHING LINE [ ] ............ ..... 'D' Box ..._ Type Filter Material .Depth Filter Material _._..... ----...._'.. -•............... i Pro a Line Distance to nearest: Well ---------------•-••--•-_ foundation :.'___..._...........:.. p 1 SEEPAGE PIT ( ] Depth Diameter Number ..................... ...... Rock.Filled Yes ❑ No.�1 , Water Table Depth ---:.............:................ ...........Rock Size ----• --•-- -•---••---•--.., Distance to nearest: Well ..Foundation .................... Prop.�tirse ............... -- I REPAIR/ADDITION Prev. Sanitation Permit# Date .........................•.--•-- I `. 4 s l �.�. . �g --------- :_................ Septic y Requirements -----_...._ ,. en' ) : .Disposai Field {Specfy Requem ---........ . ._ ' - - ... ...................... .._..__._I.................................. _ ----'•----�� 4lDraw existing and required addition on reverse si e I hereby certify that I have prepared this application and that the work will be done in accordance wish San Joaquin F County Ordinances, State Laws, caned Rules and Regulations of the San Joaquin Local Health District. home owner or liteea sed agents signature certifies the following- "I ollowing:"i certify th i theperformance of the w for this per t is issued, I shall not employ any person in such manner as to becom b• to Workman's Com !natj n Laws of Cali rnia." .. Owner Signe .__..... --- -- -- . ---•.......---••--•••••......-----••• itle .._................... ........ . {If ath r than owners � • ., FUR DEPARTMENT USE ONLY APPLICATION ACCEPTED ay ,......... ..................•-•---•- - --•-----••-----------------•---•---------- ........... DATE BUILDING PERMIT ISSUED ..__......--'�.:.....:......:.......:....... .................................................... =-----------=--•....................DATE,.......................-----•-•----------..... ADDITIONAL COMMENTS ........................... ------... --•---•----•-------- .................--• ....-------::...---------:..--------- ••-•-..._•..... . r E - ..............................__..__.......____................. . i ......................................................•_ .. .................. • _..._.........__..._ _.___._....__- _....__..._....... __. ....._............... _ Date .��"�••.. .... ..................... ' Final Inspection b _ ..........................--••..........................•.-__. ] SAN JOAQUIN LOCAL HEALTH DISTRICT 7 9G, .,A n_.. CIA __-