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vR vrric,x • -_- APPLICATION FE?r SANITATION PERMIT C IComplete In Triplicate) Permit No. .7S-- .......... 7S 837 ....._.__... This Permit Expires I Year From Date Issued . ..... ...............•----..._---•--- i Date Issued /a.a.� -7S� Application is hereby made to the Son Joaquin Local Health District fora permit to construct and Install the work herein described. This application is made in compliance with County OrdinNo. 549 and existing Rules and Regulations: ance I 108 ADDRES5/LOCATIONS. / ..C��/ �� k Owner's Na -�- i ...CENSUS TRACT ............................ Address _��.��L37�C.�- .�.C�/lf�_..��.' �-_�' =- ..Phone -. ..--7�1._�•-.�".,� f � �- Contract .... ...........Ci - ..--�. ��...�/ - or's Name � ------------------------------------------ _...License � ......__..--••------ --•-•------•---••- _ Phone Installation will serve: � ..•_...._ Residence --- -••Court • (�Apartment Hou -j--- of I' I �� Commercial[)Trailer Court � g Motel ❑Other..-.._..._._ :vin units:=-- ----•- Number of bedrooms ...r.-__-Garbage Grinder ......... Lot Size .........._ Water Supply: Public S ystem and 'rsame ....................•- Character f ...................................... _Private _ Of soil to a depth of 3 #set: Sand -••'•""_"-•""'-•"'-•- Silt.Ej Clay ❑ Peat❑ Sandy Loam Hardpan fl Clay Loam ❑ , P ❑ Adobe Fill Material ...___......If yes,type ' {Plot plan, showing size of lot, location of system In .relation to wells, NEW INSTALLATION: - buildings, etc, must Abe placed on reverse side.) ' (No septic'Aank or seepage pit permitted if public sewer is available within 200 feet,j I PACKAGE TREATMENT I I SEPTIC TANK / CL Size ------------•-• --•--- .... Liq CapacityD . uid Depth - ------ _. .--- TYP$ •__....... Material........ •-"__-•. No. Compartments s- stance to nearest: Well �` ............... LEACHING , LEACHING LINE •__•t� 4 � • ---------•--------.Foundation ..::.................. Prop. Line _---...__....:_. ,1 [ No. of Lines ___.� •••••.lv ----------- Length of each line.----- ...... ........ Total Length ........... 0 t T e Filter ................. '�' 13ax _. .;!_.._.. yp Material i Al'+ksa..Depth Filter Material .._.._•j-t . X �3(, -j Distance to nearest: Well s?>� Foundation ` } -` •-- - ......... Property Line .. { SEEPAGE PIT �----- ---.. Diameter �- - � ........................ F Depth . X --• Number .._..._�. Water Table) Depth •• Rock Filled Yes e� No p Rock Size . .........- - • I Distance to nearest : Well ..........wel-_ REPAIR AD •-------. Foundation Prop. Eine REPAIR/ADDITION Sanitation Permit t4=` ---•----•---------------•---•_ } ----.. Septic Tank (Specify Requirements). - pate --••---•--•- P Disposal Field (Specify Requirements) __-•-_____. ..........I. ..... i ---- ------- . ----• --------•-----•--------------------.............,......... ------- ........................ -------------------•------•-----••------------- ,---------------•------- - _ ......... (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 San loagui County Ordinances, State Laws, and Rules and regulations of the San Joaquin Local Health;District. HoneC sed agents signature certifies the follawing: s ewner or liten "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 b me sAject to Workman• m 1 pensation laws of California." Signed _ . t - 4, r ------•-----•---------------• - Owner (If other than owner)-------------------- -----------------•--------------- ,Title - ------------ ..... . . FO D ARMNTPTUSE ONLY APPLICATION ACCEPTED 8Y _.-- ` BUILDING PERMIT ISSUED -------------- ------.. DATE ADDITIONAL COMMENTS - •._..._.._ ---------------------DATE . ...... . ------... •------ -------• -. -.__-,.- _._..... ---------••--- -•-•------ ---------• -----•---- -----•--- •----•------- ---------------•----•----------- ...._..__. -------------------- .............. Final Inspection by: -•----- • ____ -_---•-••--•----------•--•-•----------------------------•---•-- EH 13 2h 1-68Rev. 5MI ...._.--•----•----•--------------------------Date .....�.1- - i SAN JOAQUIN LOCAL HEALTH DISTRICT ��- �M __..._.