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FOR OFFICE USE: FOR OFFICE USE: - APPLICATION FOR SANITATION PE!a MIT _. ... 4/ 6'' (Complete in Triplicate) Permit No. 1.j. Dare Issued ..............................._.. _._. __. .. This Permit Expires I Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work herein des- This appiication is made in compliance with County Ordinance No. 549 and existing Rules and Rea,aations: [L...r..,.,y JOB ADDRESS/LOCAT 467;2.,f79 .. . V� . . (f1i�c� ..._ _.... CENSUTR r�r TRACT.... ... _ f S Owner's Nome . ......p Phone._ .l - .. Address ..... ✓ .. ., . City ... zip... 7S Contractors Namy .�t,� ;6F:4eptee ..-License # Azb Phon -'- t - Installation will serve: Residence❑ Apartment House❑ Commercial ❑ Trailer Co,it ❑ Motel ❑ Other....:721!4 -p —iii -. Number of living units:...... ......Number of bedrooms Garbage Grinder ..__.Lot Size ____...... .._..._............. Water Supply: Public System and name... ... ....... _ ._ __. ._...__............_._.........__-___ ....... ._ .._...__. ... ........ Character of soil to a depth o`3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam ❑ Clay can, ❑ Hardpan Adobe❑ Fill Material__.._....If yes,type. (Plot plan, showing size of iot, location of system in relation to wells, buiidings, etc. must be placed rr,,reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available wLi,in 200 feet,) PACKAGE TREATMENT I I SEPTICTANK I I Size........ .................... ........_....___...........Liquid Depth........ .__... Capacity.......-__.._.._..Type................. .....Material.........................-No. Compartments . Distance to nearest: Well ............. ............................Foundation...... .__. _._._. . Prou. Line .....__ - LEACHING LINE I 1 No. of Lines............ ............._Length of each line......_. ..__ .... ...._.Total Len in _... ...__.. . . - 'D' Box.....---....Type Filter Material.............. .....Depth Filter Material........ .._ __....... . ............. _... .. Distance to nearest:Well....... ._ ...............Foundation... ................ ..... Pn perty Line_..._...... ....__ SEEPAGE PIT I 1 Depth._.............Diameter__........__....Number......:..:..._...._---------- Rock Filled Yes❑ Water Table Depth...... _..... ............................. .....Pock Size....._.._ _.._. __ _._...._............ Distance to nearest:Well.. ............................ ......Foundation ...... ......... P3P, Line__. REPAIR/ADDITION (Prev.Sanitation Permit#............:............... _....................Date........................ .. ._. I Septic Tank (Specify Requirements) . . .. .. .. ... .......... .. . . . .... _. .. Disposal Field (Specify Requirements).. ._Lz odd..% r. .�✓-f ' . ._zee ..aJ -�`- . . . - -...._......___..... ...... ....._.. ......... ..___._..._.._......_.. . .__.._......._..._... ' .............................. --- -----" - "- " - - -- - - "-(Draw existing and required addition on reverse siclt) 1 hereby certify that I have prepared this application cnd that the work will be done in accordone with San Joaquin ; Ordinances, State Laws, and Rules and Regulations f the San Joaquin Local Health District. N.:,. owner or licc. signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I st it not employ any person in such ma, to beco�e subject to Workman - Compensation taws of California." Signed nor Title...K%�/fil!cR,.S%tai ....... .� (If other than owner) FOR DEPARTMENT USE ONLY yss c.Y-....-.. a APPLICATION ACCEPTED BY '�-T� - -�� >� DIVISION OF LAND NUMBER ..._.._.. ..._-_- /...._.... _ . ..._. __._.. ..._ C r ... .. ADDITIONALCOMMENTS........_._._._............................_.._.._._.......__.... _.._.__....._._. ...... _. --------- ............... _ ... _ _. .. . . .. _ . .. _... .._ ... r._.. ._ _............ A �1 Final Inspection by: ; � Date P �