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FOR OFFICE USE: i ,,K APPLICATION FOR SANITATION PERMIT - c. �... -� -----------------------•---•-------•.-...,...-•--•-•-•--• •• Permit No: -7 L _ (Complete In Triplicate) ...............................---- -_.. w _ , -�'s, . Thls Permit Expires ! Year From Date Issued Date Issued .................... Application is hereby made.to the Son Joaquin Local Health District for a permit to construct and install the work herein F described. This application is made-4n compliance with County Ordin ce No. 549 and existing Rules and Regulations: JOB ADDRESS/LO�ATIO i -_ ... .. .. --------------..........................CENSUS TRACT .......................... If Owners-Name. . ........... one ............ ...• ..._..-• Add � i r�!�/t' ........ City _.- .... .... . - Contractor's Name -�---------- e1 ------ ---- -- ------------- ----�--•�=�=3�-•-•-------..._.License # Phon -- --------- •- IRation will serve: '�Resi ence .Aparfinent H uo seg❑ Commercial❑TraNer Court Motel ❑other Number.of living units::. :. Numberrof bedrooms .5.f..Garbage,.Grinder ...- Lot Size ...... .... J Water Supply. Pub(ie System-and name . .......................4...�. "" "'.��...............--••-•.............................Private , Character of saillo a depth of 3 feet: Sand❑ Siltlay ❑ Peat 0 Sandy Loam ❑ . Clay.loam ❑ XHardpan ❑ Adobe Ffll Material ... ....... If yes, i. (Plot 'Oan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLAT12NDs (No'septic tank or see pa .pit,;permitted if public sewer is available within�200 feet;) �r PACKAGE TREATMENT { ] SEPTIC TAMC ize......��..�lC_!.?�..............X Liquid Depth ...,� ..............� 57 Capacity , KLM----... Type _ Material.._t ? r.: Na Compartments I ..---•----ul Distance to nearest: Well ....____..ST..__r....._._.Foundation ..:..f v..r....... Prop.'Line ..1$11... .....5 LEACHING LINE No. of: Lines ..---:_Z-7----- ..._gfh ofea line__ ...� ............. Total Length l D' Box T a Filter Material ..............er yp Depth Filter Material .._..._�.� --------- .. ...- ................ :Distance to nearest: Well ....�d t ..... Foundation ......f d__. -..... Property Line __. S ............. r SEEPAGE PIT � Depth ..... Diameter. __'33-cf.Y.__. Number .__.. . l�.... Rack Filled Yes No �❑ Water Table Depth ............................. ..................Rock Size ------• Distance to nearest: Well ........11 ......................Foundation Prop. Line " .: REPAIR/ADDITION(Prev. Sanitation Permit# ... Date Septic Tank (Specify Requirements) Disposal Field (Specify Requirements).................. . ...... ...... ....................... . . . ........ ............ .----•-. .----------------'--•----... •---•-•------- -------------------------------..---....... ......._......... .4 .........,..._.... . ..........................................--.....----------------.................................,.................................................................................. (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 San Joaquin ' County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work-far 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." I Signed ------------- ........ Owner By ------- ..... - ......... Title ............................... (I of er t owner) FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY .............. . ..... ... . ...................... - ................. DATE 5.....,............ BUILDINGPERMIT ISSUED .---• L.. ............. ,...-. .-.. ..... -----....- .................................... ............................ . ADDITIONAL COMMENTS t .. .-...tea, .................................... ----------------•--... ............................... ......... ...._.. .. �..-.-.. .. ............................:. . ..... ----_.. ...... ..-. ------ ---•• .... ............................ :... ._ =: c•Cs....:.--:! i -. :1 :-- /L:c:�:� .. .. - . ..... ..... FinalInspection by: .................................................................................Date .-....--�/-17-. 7 .-...-....,-.-.. SAN JOAQUIN LOCAL HEALTH DISTRICT cz�?---