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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. r+ ----------------------- ------------------ (Complete in Triplicate) _ Date issued . .-=-�---- •�/ . .... ......... -- - - -^ ------- This Permit Expires 1 Year From Date Issued 13� -��o ,ro S' e work herein Application is hereby made to the' 'in Joaquin Local Health ordinance for a No. 549 and existing Rulestalnd hRegulat ons. ermit to construct an Appapplication s mad in compliance with County described. This � � 1 CENSUS TRACT fWY ©///,VZOW-v-- Oe, JOB ADDRESS/LOCATIONo: ,. '_S ------Phone/04 --------- Owner's Name -..f�ir�r- ----��- -=� - - ------ -------------------- --------- -------- -- ----- - -------- --- Cifi Address _45A.AW { License # f-7 .-3._ Phone Contractor's Name -- ----•-i-S��-�- 5� - - ------------------- installation will serve: Residence 0 Apartment House❑,Commercial :❑Tra;ler Court ,❑ { Motel ❑Other ------------ ---- ----------------------- 1 ------ --- J Garbage Grinder / ---- Lot Size Number of living units:--/--- --- Number of bedrooms -- ------ ---•Private ❑ --- ----- -------------------------------------------- I Water Supply: Public System and name ------------------------------- Loam Character of soil to a depth of 3.feet::�Sand.'❑ Silt F1Clay [IPeat Sandy Loam ❑ C1a Y [_1-- Hardpan E] Adobe ❑ Fill Material ------------ if yes, type ---------------- ----- -- � ' buildings, etc. must be placed on reverse side.] 4 (Plot plan, showing size of lot, Location of system in re�m tted°fw wells, sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or seepage pt pe �� f Size-- -- 5 57V- Liquid Depth _ �� f PACKAGE TREATMENT [ ] SEPTIC TANK ) W, k Capacity!.b2�----- Type Material_�e,fl Compartments ------- Foundation / -(------------ Prop. Line . ---------- Distance, to nearest: Well ._., �--- --- r 10^ No. of Lines each line---- ------ Total Length -f- • -----------•---- LEACHING LINE [ _- . Length-of l' 'D' Box . Type Filter M--t. rial -----Depth Filter Material .1�----------- /� Property Line - - p rty -------- Distance to nearest: Well ----- ----------- Foundation . - ------ ---- Rock rty L Yes ❑ No �❑ Fill --.............. --.. -- ... Diameter Number -- ----- SEEPAGE PIT [ ] Depth ---------- ------------ Water Table Depth --- -- --- Rock Size - - ------------------------ I -----•----Foundation ---------------4---- Prop. Line -----•------•----- --- Distance to nearest: Well ._-------------------------- i F REPAIR/ADDITION(Prev. Sanitati n Permit# -• ----------------------------------------- I ----------------------- Septic Tank {Specify Requirements _------------------ -------------------------------------- ----------------------------------------------- ------ Re uirements) --------- -- -------------- Disposal Field (Specify q ----- ------------ -------------------- - ---------------------- - ----------- -- ------------------------------------------------------------ ------------------------------------- -------- -"--"" - � (Draw existing and required addi#ion on reverse si e I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ; and of the San Joaquin Local Health District. Home owner or licen- County Ordinances, State Laws, Rules and Regulation 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 suc manner as to bec/-------- " et to Wo kman's Compensation laws of California." Owner Signed --- --------- -- ----------------------------- - - ------- ----- Title - ------ - ---- ------------------------- - -------------------- ------- - - - - -----h han owner] FOR DEPARTMENT USE ONLY zo ° 7----- -------- --------- ----------------------------------------- --------------- --------- DATE 3' y APPLICATION ACCEPTED BY ._ -- ... DATE -------------•----------------------------- BUILDING PERMIT ISSUED .---' ----------------------""-------------------------------------------------- ....................... ---" -------------- ----------------------- ---------------- --- --------------------------------------------------------------- ADDITIONAL COMMENTS i:I - ------ --------- ---------- -------------------- - -------------------------------- - ------ ---------- -------------------------- --------------------- ---------------------- -------------------------------------------------------- ---- -- -------------------------- ,- ------------------------•----- �' ------------------------------------------------------------------ -- Date -- ----- -- - Final Inspection by: _-�-�� ---; --- - �� ---' SAN JOAQUIN LOCAL HEALTH DISTRICT ! F_ H. 9 1-'b8 Rev. 5M