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R SANITATION PERM" Permit No, FOP, OFFICE USE: APPLICATION FO FOP OFFICE USE: LIS (complete in Triplicate) Issued Dote ------------ - ----- - - --- -- --------- - --------------- 6--------- 3r From Date issued ------------ --------- This Permit Expires Year construct and install the work herein --- ------ ------ District for a permit to cOr existing Rule and Regulations-. --- ---------------------- S - -- ------ Son Joaquin Local Health District No. 549 and cation is hereby made to the ),ante with CounW application is made in comp lia --------------CENSUS TRACT --------------------- described. This application ----- ----- Phone ----------------------------------- -------- - ----------- JOB I 1ADDRESS/LOCATION ------ -------------- --------------- ---------------------------------- ---- -- --- City --------- ------ ------C -------- Own ....... Owner s Nome 4f ------------ -------- _f.3_JF_?,�7�hone ---------------------- 'Ir I : . License -------- ,j - ---- --------------- Lice s # Add --------- ress railer Court 0 1 0 Contractor's Nome ------- partment House` Commercial I I Residence I- -------- -----1\ Installation will serve:; tAotel E]other ------ ---- --------- ---------- Grinder ---------- Lot Size Private -----Garbage -------- 0 S -------- Number of bedrooms ----------- -------------- am 0 Clay-Loom Number of living units------ ------------------- ---------------------- -------I I name --------- Peat 0 Sandy Lo I ic 6stem and Water r Supply' Publ a dl epth of 3.feet: Sancill Silt 0!"1 Clay 'o .Material ------------ if yes,type ---------------------------- Charqicter of soil to Hardpan ❑ Ado94-[] Fill Mater reverse side.) uildings, etc. must be placed on in relation to wells, b 0 feet,) of lot, location of syste J available within 20 (Plot plan, Showing size -Permitted if public sewer is ova Depth -------------- eptic tank or seepage pit Liquid ION. '.1 NEW=INSTALLA1 (No S. on Size---------------------------------- Na. Compartments ----------- SEPTIC-TANK:[ I C, . PAC�,AGE TREATMENT Ty I Material--------------- ---------- pe ---4--------------- ----------- Prop. Line ----------- Capacity -------------- --------Foundation --------- of Lines ------------------------ Total Length �------------------------- earest, Well-7--i----------------------- Distance to n V_f Length of each line---------------------------- --------------------- ING �INE 11 No. ------ Depth Filter Material --------------- -------- -- LEA! Type Filter M aterital ------------- Property Line- ----------------------- V Box ------------ Foundation ------------------------ I , I , t.. Well ------------------------ --------------- Rock Filled Yes E] No 0 CDistance to nearest: Diameters=--- ----- Number ------------- • SEEP I GE PIT Depth -------------------- -----------Rock Size ---------------------------- - -------------- Prop. Line ---------------------- Water -fable DePtha - i well --------------E--------"-'------- -----7--------- ---------------Foundation --------------- Distairice to nearest: Date ------------------------ ----------- I I - --------------------------- litationPermit# --------------------- ------ - TloN(Prqv- Sal ------------------- REP lit/AdDi I . I - ----- ----------------- -------------- ---------- k�_(Specif Requirements) --------- ------------------------------------ jf --- -------------------- Septic 7691 Reqvirements) --•-------------------- - Fie., kz)p I . sposa 1� , "' ,, -------- 1. �l d (S ef I Y lo�' ----------------- Di� A ------------------------ ------------------------------------------------ ------------- reverse side) S _,�Jiiia4ul ------------------------- addition on ante with an a - -------- --- -------- ------- I I------ -------- ------(braw-existing and require e done in accordan --------------- 9 application and that the work will b strict. Home owner Or licel i i e prepared this OPP t.1ons of the San Joaquin Local Health D! I heiebY certify that F! ie Rules and Reg many County Ordi;ances, State i Laws, and all not employ any person in such the sed agents signature certifies which this permit is issued, 1 shall -1 certify i<,t in the Perf 0 rmance of the work for s of California-" �,,, 1. Workman's Compensation law as to becd1fie subject to --------------- owner, ---------------- ----- ------ - --------- ------------------------------- Signed -------------- itle --_------------ ---------------- ----------------------�_4_ --------- ------ ------ By ------------------(if--other-- - th than owner) ONLY FOR DE RTMEN'if USE O --------6- i DATE --------------------------- ---------------- --------------DATE ----------------------------- APPLIcATION ACCEPIgD BY -- --- --- --- ----------------------------------- -------------------------------------------------------------------I- BUILDING PERMIT ISSUED ------ ------------------------------- -------- ---------------------- ------------------------------------- -------- - ---------------------------------------------------------------------------------------------------------------r ADDITIONAL COMMENTS --------------------- �f --------------------------------- ------------- --- --------------- ----------------------------------------- --------------------------------------- - ------------------------------------k--------------- ------- ------- --------------------------------------------- ------ --- ---------------Date ----- -- Jt -------------------------------- - -----------------------------------------I------------------------- Final Inspection�_�- SAN JOAQUIN LOCAL HEALTH DISTRICT I-'6B Rev. 5M