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FOR OFFICE USE: /�1.an1z-d.�•+�-�.c. ��(v,o APPLICATION FOR SANiTAT1ON QERMT ' Pennit No. (Coerplaie In Triplicate) _ Data Issued ................ ;�, This Permit Expires 7 Year From Data Issued �. pplication is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein escribed. This upplicotior�jt made in compliance with County Ordinance No. 549 and exi Ing Rules and Regulation: `.: ''t'c'h� 1 /J2�... ..!.� ..::/.n�. �t..>. ....�:.%.. /TL C N �i`S Tii:AGT .......................... ADDRESS/LOCATION r I ',.vner s Name c fJ/��.11.2C .-1-!...... :................................................. ........... ddress )Ah t'//✓N �./�n'<....._ ............ ............City :7f�,n. . r cz� .................................... Contractor's Nome 1 i .�' __ 1�.1.�f/./` .............. ----.....License y.��.�..... Phone T_ ....._�� stssllation wi!I serve: Residence❑Apartment Houtao Commercial❑Traller Court [) Motel❑Other... .•?_:'.Z C.n.L`./.'.,( ... i vmber of living units: . . Number of bedrooms ........ _Garbage Grinder ............ lot Size ...'�....�n/2G�------_---. -- later Supply: Public System and nume ................. ...................................._.................... -----......._--•------------Private(s� " haracter of soil to a depth of 3 feet: Sand❑ Silt Cl Clay ❑ Peat❑ Sardy Loam, Clay Loam C � ' Hardpan❑ Adobe❑ Fill Material............If yes,type............... ....... .... lot pion, showing size of lot, location of system in relation to wells, bulldingc, etc. must be placed on reverse side.) V' NEW INSTALLVION: (No septic tank or seepage pit permitted If public sewer is available a,ithin 200 feet,) kCKAGE TREATMENT O SEPTIC TANK Liquid Depth ....................A Capacity ..� .��... . Type .+�.0.4:�:-'.. Material.....0�---!�'?._�. o. Compartments ..... -----• C'.l.,��....... .Foundation....Z.>... ...... Pro Line...6..............� Distance to nearest: Wall l � � -- - - --- p• f r 'ACHING LINE [ J No. of Lines / _._ Length of each line .... .r........ ...... Total Length ... �...._....... 'D' Box Type Filter Material�1 �. ' `.....Depth Filter Material .I/.................�..�.�------yO Distance to nearest: Well ----- �..r......... Foundation .....�.�..... ...... Property Line :EPAGE PIT ( j Depth Diameter ........... .... Number ......_.................... Rock Filled Yes ❑ No C : Water Table Depth Rock Siza ................................ .....Foundation ......... .. ....... Prop. Line .---_------------- Distance to nearest: Well ........................_........ . �.. :FAIR/ADDITION(Prev. Sanitation Permit°# ........ ................................ . Date .................................. i Septic Tank (Specify Requirements) .... .............................................................................................................. f Disposal Field (Specify Requirements) ............ .... ......... .... .......... ....... .................. (Draw existing and required addition on reverse side) hereby certify that 1 have prepared this application and that the work will be done in accordancQ with !on J*MiUln ounty Ordinances. State In Hs, and Rules and Regulations of the Stan Joaquin Local Httalth District. Home owner or licen- sed agent. ;anature certifies the following: "1 certify tha, in the performance of the work for which this permit is Issued, I shall not employ any person in such manner s to become subject to Wor an.s Compensation laws of California." gned Owner Title (If other than owner) s FOR DEPARTMENT USE ONLY - -- APPLICATION ACCEPTED BY . ...... DATE Q-. . . 7- _ _ BUILDING PERMIT ISSUED DATE UDITIONAL COM1%11Er!T1) t D7re v c,r,ol Inspert,on i.. � � �.. !i 1, 211 -r 't -OAQIIri l LCAL HEALTH DISTRICT 8/7h 3r1