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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------....------ ............... (Complete in Triplicate! Permit No. :7�_....... .. ......... This Permit Exp Ices 1 Your I:retn Date.. .....-^� _. , Date Issued i Application is hereby made to the San Joaquin local Health District for a permit to construct and Install the. work herein - described. This applicaion Is r made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �y F :JOB ADDRf55/LOCATION ... ......�.r " � b -f`s�- ....CE NSLIS TRACT Owner's Name ......... .- . .......................... 1. ....... Address ... .. .....✓tea i' C ........... ...............P one ......... .......................... Contractor's Name ....... - : .. ...4c.. .cu ' :......License i fs ��lf ........... ...................... Phone ................ Installation will serve: Residence Q Apartment House[] Commercial&railer Court C3 Motel Q Other .. ....:................ Number of living units.-.,..I....._ Number of bedrooms ......5------Garbage Grinder ............ Lot Size Water Supply: Public System and name Character of sail to a depth of 3 feet: San-•-•-----:-•-••_-- .................••--••----....................-..........................................Private Q. d❑ Silt❑ Clay (] Peat Q- Sandy Loam 0 Clay Loam ❑ - , ,Hardpan ! K Adobe Q Fill Material Ifes y ►type........... (Plot plan, showing size of lot, location of system-in°relation to-wells, buildings;ets, must be plated an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted-;f-public-sewer:is-available-within 200-feet-1 i PACKAGE TREATMENT ( ] SEPTIC TANK f^7 gig ' � r ' 1•••, '`h•• Liquid Depth .... . Capacity' Type -•-----. Material....��: '.... N... - No. Compartments ............. N - (1 Distance to nearest: Wellr� Foundation :...1.�� ! ..- Prop. Line ...��,e�-r D LEACHING LINE [ ] No. of Lines .......�?....._....._. Length of each line......., --.. _•. Total Length !.� 'D' Box -----/..... Type Filter Material -s . Depth. ,Filter"Mcterial ...... Distance to nearest: Well ........ ./.�1`-_ Foundation ......., 01 t:... operty ... ,1. .... Pr tine ....... SEEPAGE PIT Depth .� �`, Diameter 3 P -- - --•- ••ems- Number .moi.:....... Rock Filled Yes [r'No Water Table Depth ... '�s ...-------- ..............:Rock Size l../ ._...r '._.._..... Distance to nearest: Well .......�A�? ... Foundation ..-..le,41:-. Prop. Line ....- REPAIR/ADDITION(Prev. Sanitation Permit ................. Date _� Septic Tank 1Specify Requirements}....:------ s .......•.......---•----•.....-----•-•--•- --••...................................... Disposal Field (Specify Requirements) -- ............. ------------.------•-- ---- ----••----------•-•-------------------------- -------------- ------------•--- --.;1. ........................................ ;................ -------------------- •- --------- (Draw existing and required addition on.reverse side! I hereby certify that ! have prepared this application and that. the work will be done In accordance with San Jeaqukp� County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loco! Heald►,District. Home owner er liven- 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 CJ2wf---------- BY ---- -------- ------------ -------- --� -• —.... Sitio --- ...._.-........ 0 o .` f (If other than owner} ....... ......�---•�------�........................ l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y ....0 -BUILDING PERMIT ISSUED ..::. - ::. ,.:-•---------------------------•-- --------.: DATE,-ST�,�" 7 _........... -. _. .. . ADDITIONAL COMMENTS ---•............. ...... -------DATE ......... _....----- -' -----------••-•---•-------•-.--- •. -•-•------------- --- -------------• --------- -•--- -------- - ------- --•----------•-- ---- ------------------- - FinalFinal Inspection by: - .......... • -----•------ --------- � ......... EH 13.2 1-6f3 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 60 t $/7b 3M t E {