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FOR OFFICE USE: APPLICATIONFOR SANITATION PERMIT Permit Na. _........................................................ In Trip w- -. _� _ (Complete Triplicate). ..�.. �,,,. ,��, �.. . _.._. v, .. . .,,. �..___ Date Issued .��..... This Permit Expires ] Year From Date Issued, ' and l the Application is hereby made to the Son.Joaquin Local ith County alth t0 Ordinance Nom549 and exisit to ting g Rulestalnd Regular herein iz described. This application is made 1n•compi an , CACT ......................._.. J0B ADDRESS/LOCATION . /G=•� f' , phone ......... ... ..................:_. Owner's Name .. - y .-" �1�.-.--................................................ f ,._. ra .... ..................................City ... .y.... o...................... Address l�'83 ` :... Phone ,�e.E . .. ...Lice nse . Contractor's Name 2�_�- ...----:�:�`.-�•��_,. ..��....:................... ............................ installation will'serve: . Residence[B Apartment House Comm erc a ❑Trailer Court fl Motel [['Other :... 3 ' Lot Size Number of livingunits....-�' Number�of bedrooms Y Garbage Grinder ..:......... ..........Prloofa E3Water Supply- Public System and name:.:.- .............. ........................... - Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat Q Sandy Loam{] Clay Loam Hardpan(] Adobe Fill Material ............ If yes,type ............... ............ ibuildings, etc. must he placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, NEW INSTALLATION: (No'septic#ank or seepage pit .permitted if public sewer is available within 200 feet,) i A .----•... Liquid Depth........................... PACKAGE TREATMENT [ ] SEPTIC TANK f I Size..............:........................ } Capacity -------------------- Type' "—............ .... Material...................... No. Compartments ....................7.\1 _ Foundation ...--:--. Prop. Line ...................:. Distance'to nearest: Well •----•-----••--• �-•'•-----"• -_----•-- ------- Length of each line._........................ g S . ... Total Length ............................ LEACHING LINE [ ) No. of Lines - - _ - 'D' Box . Type Filter Material ...Depth Filter Material .......... Foundation Property Line ........ Distance to neatest; Well .............. .._....._._...._....---- �. '- � No Q Depth � _ Diameter Number . Rock Filled Yes SEEPAGE PIT Water Table-Depth' _RotkfSize •-•--:_......---• -..._. Distance to nearest: Well .................:....................._Foundation ................:._. Prop.tins .........:. REPAIR/ADDITION(Prev. Sanitation Permit# -._...--------------- •-----•.......•-- Date ----•.•----=-•--.... ) Septic Tank (Specify Regirireri)en#s) .... . Igis of Field (Specify Requirements) ( existing and ra __..----- = ------------ ---- -• ---- : ........._........- - Draw required ddition on reverse side) I hereby certify that i have prepared this up plicallon and that the work will be done In accordance with.San Joaquin. County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;Dlstrict. Horne owner ar licen- sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for which this permit is Issued,.I shall.. not employ.any p as to become subject to Workman's Compensation laws of California." we Signed er "". " p . __..._...- (If other than owner) FOR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY __"' ------------ DATA.. .. .._. /-. BUILDING PERMIT ISSUED ...------ -- :....._.. ADDITIONAL COMMENTS ----------------------- -- -- -' ................... ------ ------ ------. ._....... ..----••----- -•-•------ ......................................... -------•..._................... -. _ Date �� - •--- Final Inspection -- $ EH 13 .21 1-68 Rev. 5M SAN AQU1N LOCAL HEALTH DISTRICT �7)i 3M r