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PLM OFFICE Wei i� F APPLICATION FOR SANITATION PERMIT � . .. . . '� IComplete In Triplicate? Permit No. ..7 j /0 S� ........................... ................. . Thls Peronit Expies 1 Year f�rora Dah issued Date issued 1� Application is hereby evade to the San Joaquin Local Health District for a permit. to construct and Install the work herein described, This application. is made In compliance with County Ordinance No. 549 and existing Rules and Regulations, 108 ADDRE55/LOCATION;i � . ............ ..... ...::d.... ...................... ............,.:.:..CENSUS TRACT :..........� .........: Owner's Name _ :4% .............Phone Address ... .... ........City ... ter Contractome`r's-Na :l,F._ ,: Y :. r te- . .................Llasnse # .... ...:------ Phone . s. .—r... ,!... # Installation will serve, �- 1 esidence partment House Commercial❑Trailer Court 0 ,cwt 3 Motel[]Other, r- .. ' } Number„of living un its:_...' ._.... Number of bedrooms _.. ! g !_.:Garbage Grinder ............ Lot Size ------------------------------•_•__-......... Water Supply: Public System and name •----}_____:._._________________.... ................................private Character of sail.to a depthlaf 3 feet: Sand❑ Silt[) ---Clay ❑ Peat❑ Sandy loam ❑ Clay loam ❑ (n Hardpan❑ Adobe❑ FillNiaterlal ....---•--.. If, as,type............... ............ (Plot plan; showing size of lot, locationof system in relation to welts buildings, etc, must be placed an reverse side. NEW lNSTALWTfONs (No septic tank or seepage pit permitted If pub!rc sewer Is available within 200 feet,) PACKAGE'TREATMENT { ] SEPTIC TANK ] . Size. ...... Liquid Depth ........ € F Capacity `* ��.� .. . terial........... .......... No. Compartments ................... s ' Dlztance to nearest: WetY .. ."2Z ........Foundation AO 6 Prop. Line LEACHING ( ] �. of Lines _._..._......_____...... Length of each line............................ Total Length Type .Depth Filter Material Q...`.............................. NE Na I � r 1 Box . ......... T e Filter Material _ :�-_ . Distance to nearest: Well ' ...... Foundation ........................ Property Lime ............. SEEPAGE PIT [ Depth .............. ..... Diameter ......_______._. Number _..---_...............___... Rock Filled Yes C] No Q }' Waiter Table Depth --------------- ----•-•.........................Rock Size ................................ Distance to nearest: Well Foundation ____________________ Prop. Line................ .....- i fi!FPAIR/ADDlTlON{Frau. Sanitation Permit ! ............................................ Dote ...................................I Septic Tank (Specify Requirements) .................... ........................... ...... ...... .... .. ......:.... -.....:............. Disposal Field (Specify Requirements) ....r .. .��. . ........,7�..-c. ! .......................................... ............ ..#.......................................------- --.. ------.........................._.....--.----•••...._.......--••...........................-----....._............................. :F _ (Draw existing and required addition an reverse side) I hereby certify that i have prepared this application and that the work will he done In accordance with San Joacitrl { County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcew' sed agents signature certifies'the following: "!.certify that in the perfbri6ance of the work for which Ihis permit is.issued, I shall not employ any person in such manse j man's Cc pensatlon laws of California." a9 to become subject t© Wo Signed .._._._ --- ------ ......... Owner _ Yitle .........................................................::...---•--•--- IN other than towner) q FC DEP TM�I USE ONLY 3 APPLICATION ACCEPTED By .. - ................. ...-----•.....I DATE . .....A0 ...lp..._. BUILDING PERMIT ISSUEDt._ DATE ..............................•--•.'....... .................__..._......---...._._._ .. ADDITIONALCOMMENTS ..........-•-•---............................._..----.........---.............. ..:........................... .......................................... •ij . --.._......_--.... . ----:---- '. ....:-- .................................................................................................. ..................... .... ........ ................................ .................... ................. ......................... j..... ----- ........ . Final Inspection b ..............I......._...------..._....._.Date . ^. . EH 13 24 1-681 Rov. 3 � SAN .10AQUIN LOCAL HEALTH DISTRICT s�74 � i j