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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT a ....... /DC7 IComplete In Triplicate) Permit No. .7................. Phis Permit Expires 1 Year from Date Issued Date Issued .• '.C{3— 27 C�.-2� Application is hereby made to the Son Joaquin Local Health District for a permit to constAuct and. install the work herein described. This application is made in compliance'with'County Ordinance . 549-and existing Rules and Regulations: 2-0 JOB ADDRESS/LOCATiO :('. �'cfi�`� �IX�� ..... .., ..�GO�'4..CENSUS TRACT" ........ Owner's Name _� r. ......... .... . ------ ----••••---- ...- one ...;. e • Address ......... 3. ' -- ----...J ...............City --.%M;_4...;W.................. ......... Contractor's Name .............. i .. ?� ...............License #' Phone Installation will serve: Residence Apartment Hpuse Commercial tDTrailer Court E] Motel Other Number of living units:-.- _ Number o bedrooms -.----------Garbage Grinder _._..... ... Lot Size ......... ..............., Water Supply: Public System grid name .. ............ ..............•--.............._-....................................................Pr€vatex Character of soil to a depth of 3,feet: Sand❑ Sift 0 Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ � Hardpan❑ Adobe❑ Fill Material ............If yes,type (Plot plan, showing size of-lot location of system in relation to wells, buildings, etc, must be placed on reverse side.! � NEW INSTALLATION. (No septic lank or seepage pit-permitted if public sewer is available within 200 feet,) - r z®....._.... -•---..... .. ........... PACKAGE TREATMENT SEPTIC!T NIC E �.__X_ Liquid Depth.. -5 ��.� erial Capacity=;` . TYPe -. Mat .... No. Compartments ......�........ �} • `� *` Distance.to nearest: Well ..... . Q.:................Foundation ......t A.':L.... Prop. Line ....��. ....... LEACHING LINE No. of[Lines ................. Length of each line..-------6. .......Total Length .-4�Q..-............. T� +1 'D' Box ------------ Type Filter. Nkateriat�'�X� -#•---Depth Filter Mater ............................... i r Distance to nearest: Well ..... Foundation .......1 Q.. rst'_ Property Line .. .`.�' �' !°,' SEEPAGE: PIT Depth ��, _..,___ Diameter `� !.. Number __....._f.. 1a.t_ R k` F€fled Yea No -A-!44%X, j Wa ter Table Depth - ----Rock Size f �-��.t?�s .��.._.. ---- #i, Distance to nearest;I Well ----,......,��f.I.........•I....Foundation ..../.0....�... Prop. Line .._. ... .._.. REPAIR6AI)DlT10N#Prey. Sanitation Permit# ...................... ......�....._---- Ddte _.-----_:.•.-. .................=) Septic Tank {Specify Requirements) �..�_.. ........................................_..-----....._..--•--.._.............__..._..........--- Disposal Field (Specify Requirements) ._.--- ................................. I _ !_ 1 1 I . - ----<- -•- . ...................................I..................... -tZ (Draw-existing and required addition on reverse side) 1 herebi certify that I have prepared this.-ppplicatlon,6d.that the work will be done In accordance with San Joaquin County ordinances, State Laws, and Rulestand Regulations ON"he Sari Joaquin Local Health:District. Home owner or licen- sed age1its signature certifies the following: "I certify.that..in..the.performance-of.tho w-oirk.for.which this.,permit,is.i:sued, i.shall.not employ-any_persoh.in such manner as to become subject to Workman's-Compensation laws of California." # \ Signed _... Owner ------- By � title ------- (If othr t an owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __r7-_�_ .. . . .. ... -- .-..... DATE BUILDIN13 PERMIT ISSUED •...-• .............. _._...............DATE ...--•• -.-•-•......•---•----••------•---- ADfl#TIONAL COMM TS ---------------------------------------------- -------- ---------------------- Final Inspection by: .. _.. ....--•-- ---•-•..--•---........ - ................Date _. _._ � `. ... EH 13 `! 1-613 Rev. SAN JOAQUI LOCAL HEALTH DISTRICT 3M i s