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FOR OFFICE USE: APPLICATION FOR SANIYATION PERM --.....---.€:............................. iCotmplete In Trlplkate) Permit No. .., S This Permit Expires 1 Yom From bole Isswd Date Issued Application is hereby made to the San Joaquln Local Health District for a permit to construct and Install the work heroin described. This application is made In compliance with County Ordinance No. 549:and existing Rules and Regu[otia►s: r JOB ADDRESS/LOCATION .1.. .. .�>7...-_........ ..... ...... �I�-�,.oz•�..�D r Q � ..........CENSUS TRACT Owner's Name ......_�(.5p1. 1�..... ��...� r� ......_ Address _1.............�. ..1. '?. ...... ... .._. Phone Contractor' ' {"�•.,City ... ............. ................ Contractor's Name ................. . ... .. ... � ...........-. License# Installation will serve: I Residence)}Apartment House O Commercial❑Trader Court O Motel 0 Other............................. Number of living units:....../... Number of bedrooms ..—'7..... a Grinder ............ Lot Size ...lQ.. ............ Water Supply: Public System and name ....... . N' Character of soil to a depth of 3 feet, Sand .........................._........1...._......_.... .. ................... .............:.....Private ❑ Slir E3 Clay ❑ Peat❑ ',.Sandy Loam❑ Clay Loam ❑ Hardpan IW Adobe ] fill Materiai• If yis,type............:.. (Piot plan, showing size of lot, location of ...,......�•�� system,in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATIONi (No septic tank ar seepage.pit permitted if public sewer Is available within 200 feet,} PACKAGE TREATMEMT 13 SEPTIC TANK •_ Capacity -............... ... Type .................... "e►ltd. ......---....... ..:..No. uCompartments ..:.................. Distance.to nearest: Well on ' Length .......... Prop.Una-.... ............. S' LEACHING LINE [ } No. of Linos th of each line....-. .... Total Length "~ *D'_Box ............ Type Filter Material ....................Depth filter Material .............. ..._. . ..._............... r. Distance to nearest: Well ........................ Foundation ................... Line SEEPAGE PIT [ ( Depth .................... Diameter.-'.) ..... Number Property ;.......,, � •�• • •............. . .......... Rock Filled Yes ❑ No (] . Water Table Depth •---•.......................•-----._............Rock Size .............................. J Distance to nearest:Well ........................................Foundation Prop. Line ") REPAIR/ADDITION(Prev. Sanitation Permit#. ....._........ ........ _. 0 ............... Date ............. '. . Septic Tank (Specify Requirements).-------------- ........./..:................. .. ............_... ......_......._.... ----- ............. ....... GPS Disposal Field (Specs Requirements) ---------- �" ' " 2A ....... .. ................. .. ..................................... . (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 loaq County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.District. Home owner or llcen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, 1 $halt not employ any person In such spanner as to become subject to Workman's Compensation laws of California." Signed ............ Owner BY ` Jitle ...... of er n owner) ..�- FOR_ MOAy#T RTMENT USE ONLY APPLICATION ACCEPTED BY_....C... BUiLDING PERMIT ISSUED ......... DATE ... �.. ,-. -.? ...... ADDITIONAL COMMENTS ............. :........ DATE........................... ...............................................................I...................... ..................... Final Inspection by: ................................................ •--......... Ll� EH .. --•-----• ............................................. .... ....._.__.........Date .. :''z` .........,..._............ 13 2b 1-6v' AN JOAQUiN LOCAL HEALTH DISTRICT 8/7!i 3M