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FOR OFF.iCE-USt: APPLICATION FOR SANITATION PERMIT 16 y Permit No. --7 ~----fir---- (Complete in Triplicate) �``•� Date Issued '� ------ -� This Permit Expires 1 Year From Date Issue �� , he work Application is hereby made to the ermit to con Son compliance Local with Counealth tyrict for a Ordinance No. 549 and existing Rules tand t Regulationsf herein described. This application is mad p 2; _CENSUS TRACT JOB ADDRESS/LOCATION . ! ' `/� .?Z_ =----Phone _�-- -��--�•-----------------•-- 0.>X.ri•'t a-{'------- ---------------------------=- ------------ Owner's,Name ------ -----,�1;'N-�-- ---� � �.._ ' ••- 1^E�-1 Y`etl City�'* z'G�g-: =-------==------------------------ Address ------------ 9 ' �` _ Phone -------=------------- •------- P�! __ --- - -- / --------License # ------ -:------------- Contractor's Name _--____-. 3 __ .Installation will serve: Residence partment House❑ Commercial :FiTraller Court 0 Motel ❑ Other ------------------------------------------- i Number of living units::'_/------ Number of bedrooms- _.-----Garbage Grinder ----__ Lot Size ----------- ------ s e ] Private ❑ Water Supply: Public System and name ---------------------------- ------------------------------ -- ----- Character of soil to a depth of 3 feet: Sand' 1t fl ''Clay E] peat E] `Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe'0 Fill Material ------------- If yes,type --•------------------------- � buildings, etc. must be placed on reverse side.] (Plot plan, showing size of lot, location of system in relation to .wells, NEW INSTALLATION: (No septic tank or seepage :it permitted if public sewer is av ilable within 200 feet,] iP " - Size------------------------ ------------ --------- Liquid Depth ------------------------ PACKAGE --------------------.-PACKAGE TREATMENT [ ] SEPTIC TANK![.] I � i --__ - No. Compartments --------------•--: T e Material p CapacitYl-------------------- YP - k Distances to nearest: Well ____---______ Foundation -------------------- Prop. Line -------------- ------- LEACHING LINE.- [ ] No. of 'Lines ___------------------- Length of each line'____-------- ---- ---- Total Length r -------------- 'D' Box I----------- Type Filter aterial - ==-=-----Depth Filte Material` -------------------• j____ Foundation ----- ----- ----------- Property Line Distance to nearest: Well -. ____--_______.- Number � _ _ .__- _____- Rock Filled Yes ❑ No SEEPAGE PIT [ } Depth _ Diam er -------- ---------------- Water Table Depth -------- ------------------------------•----Rock Siz - - ------------------ ---Foundati --------------- --- Prop. Line ---------------------- ' -------•-------•- Q • Distance to nearest: We REPAIR/ADDITION(Prev. Sanitation Permit ------------------------------- ------------- ------- Date, ----------------•----------------•] -- - ------ Tank (Specify Requirements) --------------------------------------------------------- Septic - Qisposal Field {Specif Requirements] --- . _2_41 ------------------------- ---------------2 --------------------- ---------------------- ---- _ - --=-- ---- -- --- -- - ---------- — = a -------------- ------ - - (Draw existing and required addition on reverse side) ,. r I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health_.District. Florae owner orlicen- sed agents signature certifies the following: t "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." Signed -- -------------------------------------------------- -------------------------------------------- Owner ------------ litle ---------------------------------------=---- --------------------------- [if other than ow t{ FOR DEPARTMENT USE ONLY I J� ` ''dG"� DATE == APPLICATION ACCEPTED BY -------------- --------- ----- DATE ------------------------------------------ BUILDING PERMIT ISSUED __.-.___-_ ----------------------------------------- ADDITIONAL COMMENTS - -----=--- ----------- ---- -------•----------------------------------------------------------- } ------- --- -- - ---=------------------------------------------- -- Date Final lnspe - - ---- -�-- - -- Yt SAN JOAQUIN LOCAL HEALTH DISTRICT F. H. 9 1-'b8 Rev. 5M. ,