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FOR FFICE USE: APPLICATION FOR SANITATION PERMIT � i IComplete in Triplicato) Permit No. .. --- P� ...... _ a Date Issued .la-3 This Permit Exp€res ] Year Ik om to Iss ed . ........ t r Application is hereby made to the San Joaqui oval-Health -ist i r permit to construct and install the work herein described. This application is mciple in cornplicince with County Ordinance No. 544 nd xisting,,vles and Regulations. JOB ADDRESS/LOCATION SUS TRA U _.__..... _ ...._ Owner's Name .. � �� . . . ne .. ..... ..l EN Address . ................ � .._. o ............................_ --•.. ,.... . .._�/" ....... City Contractor's Name - - Ph on . .. ..1__._._..:_. -. =��SeO .License �,..,�� P onInstallation will serve: Residence Comriiercial oTrailer Court 0 Motel []Otter------ .................. . Number of living units.-,,.-/... Number of bedr s _ li° � o .._..._Garb a Gri der -/-�/�..... Lot Size _. ._..... . i Water Supply: Public System and no -------- .._ __. Sand❑ eat - •---•..............-......._............ r Private ❑ Character of soil to a depth of 3 feet: 'tilt Clay ❑ Sandy Loam 0 Clay Loam ❑ Hardpan[] ' Adobe iN Material .��.. !f yes,type`.............. .......:... f (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 tank or seepage-pit;permitted if pulalic sewer is available within 200 feet,} PACKAGE TREATMENT IJ '{ SEPTIC TANK Si e...�,t .7................... Liquid Depth . z k Capacity - P Y Type �" � o. Compartments . . . .._ Mater€a _ 1 v Distance to nearest:•Well .__, • , _ Fou dation r Line . x .... � - .- Pop ........ ............ LEACHING LINE No. of Lines ..... ` Length_.o ach line. __. Total Len th ��T'o 1. ...�._ ' 'D' BOX l y/ ......................... �- /to � Type Filter Material Q4�'.___.Depth .Filter Material Distancnearest: Well / I ._.:..__ Foundation ---A0............. Property Line SEEPAGE PIT Depth `r� � . - »�_ IJ — -- w�. ._ � �-,.. ( p Sy-_.-.--.. D,ameter _2-: . ..-"Number .-------•- :.: Rotk Filled Yes M----'No 0 Water Table Depth -------:-.7 ------------ ...Rock Size 0 � ' Distance to nearest: Well )/ ti� /- .Foundation • Prop: Line-..._5 / REPAIR/ADDITION(Prev. Sanitation Permit# ..................... ..::.._ Date Septic Tank (Specify Requirerrienfsl ............................................... - Disposal Field (Specify Requirements) t ............................ . ----------------•-----•------ F --•----••---•---------•-----•--- ----- --•--- ._..._.... .................................. ------------------------------------------------------------ - ------------------ ----------------...----•............................... .. {Draw existing and.required addition-on reverse-side) x I hereby'certify that I have prepared this application and that the work will be done in aecordanee with San Joaquin F County Ordinances, State laws; and Rules and Regulations of the San Joaquin Local Health,District. Home owner or Iteew sed agents signature certifies the following: ; "I certify that in the performance of the work for which this permit is issued, I shall .not employ t p Y an y persen in'such manner as to become•subject to Workman's Compensation laws of California.,, Signed _ ---•---•---•--•-••---....... Owner , By __-------- - _-. I".11 a#her h . ...- Title ------- ownerl FOR DEPARTMENT USE,ONLY . ` APPLICATION ACCEPTED BY DATE BUILDING PERMIT ISSUED .-,----------------- - "' -- ----------- - .......©ATE ------------------ ADDITIONAL COMMENTS ---------------------------• - -- .....----••------- t ..................................................................... ... .. ........ -------- ----•----- ---------- --------------------------- --------- ------------------------ Fina[ Inspection b .�_.jam,• r P Y= ------- - -- -• . ... .... ........ .. ..� .. ©ate .... EH H 13 2L 1-68 Rev. --•--- -•- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M