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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT 7J/ 3e 3 ..._...•. Permit No. -....•••- (Complete in Triplicate) ............................•-.----•---•--....... Y .................... This Permit Expires 1 Year From Date Issued Date Issued ..� �..��.. Application is hereby made to the San J quip Local Heal-4h District fo a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: J06 ADDRESS/LOCATION 7,0. --..-. ._-•- /,/y . _ CENSUS TRACT .•........................ Owner's Name .., �, T,r -._... f�� z'� -----Phone ` Address .. ........................................ City T� J! ------- .......... Contractor's Name ._. - A�_W/1- .........................License # Phone�o.�:71,z Installation will serve: Residence ❑Apartment House❑ Commercial []Trailer Court 0 Motel JXOtherIiW_.�f-?� lY ..._ I Number of living units:_:_ Number of bedrooms .'777 ::1arbage GrinderLot Size ....................................... Water Supply: Public 5 stem and name ---------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam [❑ Q Hardpan ❑ Adobe N, Fill Material --- -_---- If yes,type ____________________________ (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed-on reverse side.} oV NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size........................................ [ } � ] ... Liquid Depth ............................ .• Capacity -------------- __ _. TyPa .................-- Material No. Compartments ...................... Distance to nearest: Well ____________________________________Foundation ____.___.__---._-__ Prop. Line ................ LEACHING LINE [ ] No. of Lines ---•._"• --------------- Length of each line"--------------------"------ Total Length --- ....... 'D' Box ----------- Type Filter Material ............. ....:.Depth Filter Material '' Distance to nearest: Well -----------_ __ ` Foundation .................•__-.:. Property e SEEPAGE PIT [ ] Depth ------------ Diameter ................ Number ............................ Rock-F.illedi`-Yes ❑ No b j Water Table DepthRock Size t t Distance to nearest: Well ........................................Foundation ......._ ........... Prop. Line ........._............ REPAIR/ADDITION(Prev. Sanitation Permit=# ............................................ Date ....._.......-.................... ) SepticTank )Specify Requirements) --------------------------------------- -----------------------------------•_....-•--•---.._...._......_......--------------.----...... i `. Disposal Field (Specify Requirements) ..../:7... ... 14. 1p.....X-_,/p_ __________ --------------------------------__-.-----_-- ......................... -------•-•---------- _._ ._-.._...........-----••-•--•-•-•---• -------- .....................................--•...-------I........ ------ ..._..----------•------------------------------- .......................................L--------- --------------._...------......... (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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, biome owner or licen- 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 any person in such manner as to become subject to Workman's Compensation laws of California." f ^I Signed ..........................••-----Zneri ---- - _ _- ---------�-•-................... Owner (If other than FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......... .................. ' .............................................•----•---•--•. . DATE .. j...�..��_...... BUILDING PERMIT ISSUED ---------------- DATi: ADDITIONAL COMMENTS .............. = = _ ==...... _ ..............................--------•-•---•--•--• --•-•--•-- ... --........................ -------------•---- •--•. ................•-------------... ----- --....__...................-•---•--................---•---...._...._•-••••-•............. �•_._. _ -_.._. ................ - • ---- - .Date =S_:.: :.: - . Final Inspection by. ..... -: "____;_.•- SAN JOAQUIN LOCAL HEALTH DISTRICT r u 13 24v ce n_-. ci• 717') 11 u