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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT -------..............11................... Permit'No: .. 3`.97... (Complete in Triplicate) A ...............I......_..---•........ This Permit Expires I.Year From Date Issued .........................IN" . r.\ Ali Application is hereby made to the Sah Joaquin Local Health District for a permit to construct and install the work'herein described, This application i�5' mode in compliance ith::County OrdinanceNo...549 and existing Rules and Regulations. w oe JOB ADDRESS/LOCATION ...._.. ._7 ------Aell&.......................CENSUS TRACT ..........I.......... Owner's. NC.O6' .......... ....... . .... . ....... e..... .....Phone .............................. ...... Address --------- city ........ ...... ................. .......... ............ f4 I P Contractor's Name -------- ..........:...............license Phon . ............ Installation will serve. Residence gApartmentHouseo Commercial oTraller,Court 0 Motel 0 Other ............................. ......... Number of living units:----A Number of bedroorns. -9.....Garbage Grinder 116,0.1;�. Lot Size ............. Water Supply. Public Systemname ------------------------------------ ----------- ........... ------- .......................... Private Charactler'qf.soil to a depth of 3 feet: Sand❑ Silt F] Clay ❑ Peat❑ Sandy Loam X Clay Loom 0 Hardpan ❑ Adobe C] Fill Mate-rial ............ If yes, type ............................ ;Plot plan, showing size of ilot,, 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 public `ewer is available within 200 feet,)I 1 .4 a / PACKAGE TREATMENT SEPTIC TANKX Size,41> f ............... Liquid Depth Cal acity .... Type Material No. Compartments Z._.............. Is A007.'Or...... Distance to nearest. Well .... Foundation .;z4r........... Prop. Lin OF, Distance Lines ------21.............. Length of 9ach line ............... Total Length ;Z,4w. ............... LEACHING LINE No, -I A 'D"13ox- Type Filter Materia/kera'Depth Filter Material , ......... .......................4_5: 0 Well .1-11tf.r--------- Line .. ....... ....... ...t— Distbnce to nearest. Povndatio W .......... Property 40 tSEEPAGE PIT ..... Number Rock Filled Yes,& I Depth .,0 ..... .... Diameter ........ Water Table Depth ----!..�p.......... ......................Rock Size Distance to nearest-, Well .../__. ......................Foundation ..... Prop. Line . .......... REPAIR/ADDITION(Prev. San' itation Permit ............................................ Date ............I................... 1. $. ............... Septic Tank (Specify Requirements) ............... --------------- ......... ......... ...---•--.....---•--........................_--.... Disposal Field (Specify Requirements) --------------_- ..........................................................a.....................•.._...------------------------_- --------------------__...................1�1 .............•--------------•---•-•---I-------------------•---- I=-------------1.................... ------------- -------------------------------------I—.........sh- ---------- .................................................... (Draw existing and required additionon-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 Gws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- 11 0. sed agents signature certifie'!s the following- "I certify that in the perf*r4 nce of the work for which this permit is issued, I sholll. not employ any person in such manner' as to become subject to Woflit kman's Compensation laws of Californla.'7' Signed --- ------ - - ------IL.---- .............. .... Owner ......... ----- --------- By ........................... ........... ....t------------• ........... Title (if .er than owner) X FOR DEPARTMENT USE ONLY i ------------ APPLICATION ACCEPTED BY .............. ........... ,BUILDING PERMIT ISSUED .i............................ .................................�.. ......L.................DATE ........................................... ADDITIONALCOMMENTS .0..............................................................................................-1.......................... ............-l:............ ----------------------Ak ... ................... .... ....................... ....... ........................... .......................... 4] --y......' ..........7----------------------------- ..... ................................................. ......................... ...........I................... .......... ........... ........... ----------------------------------- ------------------------- -------------------------------------------D..... Final Inspection by.. ........................... ................................... ate ............ SAN JOAQUIN LOCAL HEALTH DISTRICT r- w 13 241_'AA RAV 7172 3 M