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FOR OFFICE 115E: ea-,41,4, APPLICATION FOR SANITATION Paw (Co nntete In T licafe) Permit No. . ................. t. This Permit Expires its bah Issued Date Issued ..,!�4-se):T`5 Application is hereby made to the San Joaquin Local Health Dis ermit to construct and install the work herein described. This application Is made in compliance with Cou o. 549 and existing Rules and Regulations: JOB ADDRfSSILOCA7Y N e..........CENSUS TRACE .......................... Owner's Name Phone 9 ,��ate'. ,. .............. .... .. ... . .. ........... .. ' ) Address .............. �1.. .. Ft-sem .............. Contractor's Nam - ----....Li rJ1�c�.7� . Phone a. s .......... Installation will serve: Residence Apartment House Commercial urt 0 Motel ❑Other................................ ....... Number of living units ..... Number of bedrooms ---1------Garbage Grinder ...... ze [V V _ Water Supply: Public System and name ................ Private ........--------- ------... iv Character of soil to a depth of 3 feet: Sand❑ Silt© Clay ❑ Peat C] Sandy CIQY Loam Hardpan❑ Adobe Fill Material ............ If yes, ...... ............ (Plot plan, showing size of tot, location of system in relation to wells, buildings, etc. mviv placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,} t PACKAGE TREATMENT [ ] SEPTIC TANKS ] Size-.............................................. liquid Depth ....................... Capacity -------------------- Tyne .................... Material...................... No. Compartments ............... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ j No. of Lines ........................ Length of each line........._.._...__.......... Total Length ............................ .S� 'D' Box ._._..--- Type Filter Material ....................Depth Filter Material ------...................................... Distance to nearest: Well ........................ Foundation .........._.-........... Property Line ........................ SEEPAGE PIT [ j Depth .................... Diameter ................ Number .... ....................... Rock Filled Yes ❑ No i❑ ,..��. Water Table Depth ................................................Rock Size ............................. Distance to nearest. Well ........................................Foundation .................... Prop. tine ......... REPAIR/ADDITION(Prev. Sanitation Permit# ...... ..,'/.j./.__ � ..... �-- Date .........I Septic lank (Specify Requirements) ......... V--------------------------..------------------------............._................ DisposalField (Specify Requirements) ..............--------------------------------------------------------............................................................... .................................. --•-•----••-•--------•------•-.-..................•-------- ...... .......................................--••---....................................................................................... {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 Joagsdn County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Horne 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." Signed ,-/---- _ ... . Owner BYE`". ,-r.�... 7itie ....�[ .................. (f o�her tha owner} FOR DEPARTMENT USP ON . APPLICATION ACCEPTED BY DATE ...... - BUILDING PERMIT ISSUED ...................... --•--• �-- ........ ............DATE . .--------................................ ADDITIONAL COMMENTS ...................... ...................:................... .......................................................... .....-•-•........... .......-_...._....._....... ----------------- ------------------------- -------------- .. Final Inspection by- ---- --------- Date . ----- EH 13 2 1-6 Rev' . ... S JOAQUIN LOCAL HEALTH DISTRICT 3M