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- •v1� V.IIK W\i APPLICATION FOR SANITATION PERMIT �; S-3f ........................•-- `� (Complete to Triplicate) � Permit No. ..7......._..._.. ............................... ........................ ............................................... ........ This Permit Expires i Year From Date Issued Date Issued ..... ��..7� .. Application is hereby made 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: JOB ADDRESSACICATION �{ ..--a 1>.• 12.- . ..1 . ../Ct./.:.... . . ...CENSUS TRACT ...elZ............... r ............ . ....... ......Owner's Name 4....,1 4.49 4O 4z "42,14.... Address .--__ F . y-------- __._ Gtty, -I.................................. •................. Contractors Name `~-..1 - ...-._ ., License iP 10. ....... Phone ...iti7 ......._..... Installation will seraes' i rtment ouse .... db�ce❑Apa �If Q ercial QTrail Court D lyinotel E9,Dther Number of living units:.... .of Bedrooms N Y--..Garbage rinder .....✓....._ t Size; . : Public PPIY System and name r ---.............. O. ................ ......._...._........ ..................... .. Private Water Su Character of soil to a depth of 3 feet: Sand% Silt Q, �ay Q Peat Sandy Loa Q Clay Loam p Hardpan ❑ Adobe Q Fill ial ..G.........I yes,type ............... .... (Plot plan, showing size of lot, location of system in relation,to ells, buildings, etc. mus be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permute If public sew' r is a e thin 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK( ] Size... Liquid Depth .......................... Y Capacity fdPta------ Typ�.�.:1 o. Compartments ...7.......r.. <! Distance to nearest: Well ...................Foun ... 1. Prop. Line ....r�� �EACHING LINE [ j No. of Lines -.-_.-.2---_--- --. Length of each line--.� - `- .a. Total Length ._.7s .-l__. 'D' Box ...�. ..... Type Filter Moteria�':�82....Depth ate a!\........./5 - ---------------r--_. Distance to nearest; Well ...... - Foundation -_Zjp� ------ Property'.Line ......s� .i.......... bEEPA�[�1T [ J Depth Diamet _.............. Number _--......----# . ...Nazkgfflecl No Q Water De - ......... --------------- "'R f5 e`::::.,. ----: Distance to nearest: Well ................ ........ �FoundaTi Prop. inb ----- .... REPAIR/ADDITION(Prev. Sanitation Permit# ....................... ............:. ate .................I------- -....... ) Septic Tank (Specify Requirements) ..................... ............ -----•----- �a Disposal Field (Specify Requirements) ---•-----••-----,-=,---------------------------.----------------, -----....-- ............................................. . - .._...-------- ............................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "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 _.__. ......-..__..---..--------------------------------. - _......--------- Owner By _. - ._...---- ---- ------------------------------- .. Title (if other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -. .. _s- x .--- ------------------ --- -.... DATE . .4 ..L7 .-7.6----.------ BUILDING PERMIT ISSUED � ---- ....DAoTrE . � t -- -------------- ..ADDITfONAI COMMENTS .._ .. ----------- - ..... -- ------------M1--------------- --- . . - -- - Final Inspection by. ------------------------- --- . ... . .. sf ---------_-------- ...............................Date 6Arl7>G-... . -. _. EH 13 2h 1-611 Rev. r � SAN JOAQUIN LOCAL HEALTH DISTRICT 6/7l1 3M