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{ __ APPLICATION FOR SANITATION PERMIT .......... .- .. _.-.. (Cornplete.in.Tri li Permit 7�- -- ---•.-• - p total . No. ....... i ............................... Thi6PermttExpires ! Year Frain Date Issued Date Issued - ..� ._ Application is hereby made to the Son Joaquin Local Health District foraermit to construct and insdescribed. This application is made in compliance with County Ordinance No. 544 and existing Rulestalndthe Reg lonsereirt FJOB ADDRESS/LOCATION ..I O-� o_••-.-�j C�rf � _._. --•• CENSUS TRACT _.._.•- Owner's Name ..- ----------•------- '----- ------------------•- Phone _ �_.._Ad._.,city �- ... Contractor's Name ----------- --� - --------------•-----------•-- --- � --•---------------•----•••--License --- - Phone Installation will serve: Residence ©Apartment House❑ Commercial❑Trailer Court Motel ❑.Other--- ......... - - -- Number of living units: Number of bedrooms ------------Garbage Grinder --------- Lot Size _.-_____--•_-__-• •- --------- ------ ---•-- Wafer Supply:_Public System and Warne --•--_...�__.._..,.......... -----------....• - Pri a ❑ ..__...------------- v to Character of soil to a depth o€3 feot: .Stand❑ Silt,❑ Clay ' ❑ Peat❑. Sandy Loam ❑ Clay Loam Hardpan❑ Adobe 0 Fill Material El ............ If yes,typo .....F' ......... (Plot plan, showing size of lot, location of system i�, relation to wells, buildings, etc. must 6e Placed on reverse std NEW INSTALLATION: (No septic tank Of seepage pit permitted if public sewer is available within 244 feet,) e.1 PACKAGE_T:RE . , AF ENT....[ . SEPTIC TANK Size............'------------------ Liquid depth .. - Capacity Type -.--- Material—------------------- No. Compartments ' ._Distance.to Well _,`:I-Foundation. r e - ----- ------ • .LEACHING LINEPop. Lin ._.._.� [ ] Na. of Lines nearest',. ^: .R Length of each line....--...�---•.._.-------•-•. Total � _� . g 'D' Bok -.. Type Filter Material .....:..........Depth Filter Material Length Distance to nearest: Well Foundation F .... Property Line SEEPAGE PIT � - ... _ [ 1 Depth ------ Diq eter :----------•---. Number ....-- _. .... Rock °Filled Yes ❑ No,❑ Water Table_Depth ------------•-- •-------- --••---•-Rock Size ...... rY Distance to nearest: Well - ......_Foundationpn _._... . ...... Pro , Line AEEPAIRfADDITION(Prev. Sanitation Permit# ................. ' date : .Septic Tank {Specify Requirements) ----------: - I ...-•---••--••_----- p. ------------------------------ - _ r _ Di osa Field Specify Req,uirementsE ._-_ If------ .-- ��- .............. .. ,,,.. (Draw exi ting nd required addition on 69 erse side) rf hereby certify that I have.prepared this opplicatlon and that the; work will be done in accordance with San Joaquin' � County Ordinances, State Lavas, and Rules and Regulations of the San Joaquin Local Health:District. Home owner sed agents signature certifies the following: pr l(cott- "I certify that in the performance of the wont for which this permit is issued, f shall not employ an as to beco subject to W -ma Compensation I sof California." p y Y person in such manner Signed -. L� BY -- .-------------- ------------------------------------- F -------- --•---of oth t an owner' 'Title '- ------ -------- _ --------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ._-�---- -. BUILDING PERMIT ISSUED ------- ------ _... ------=------ DATE _/4 .: -..F - ------------- -----• - _-. ------.---------• •---- -. - .. ..---DATE ........------------------- ' ADDITIONAL COMMENTS ---------------------------- -_ - -- •• .--------- ------ ------------------------ - ---- ------•--- ... - ---------- .. --------- --- ------ -------•-- ------ ----- -------------------•--------....--- ------------- ------ ------ ---------------------- .............. -----------------I------------ ' Final Inspection b EH 13 2} 1-68 jk_Ve --------------Date 1. . :. ,....-............... F. SAN 1OAOUIN. LOCAL HEALTVI DISTRICT 8/7h 3M