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aw',:rx UFFICE USEi APPLICATION FOR SANITATION PERMIT '4 .............{.................................... Permit No. ..7 .:::':....!Complete in Triplicate) , . ............ . Date Issued YW......................... ..... Ibis Permit Expires 1 Year From 06to Issued Application is hereby madejad! �iobquCn ideal Hba t istrict for a permit. to construct and Install the work herein described. This application i in --compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESS/LOCATION ... `. i...r�' !` 'QaP . ..............t.L..!..�.5.b ��..L.�....CENSUS TRACT .......................... Owner's Name .�..!C�1..7?.P...� ..a �•.:�..a:.®' ....................................................Phone ... .............................. Address ..-- �... . .�. .. '..._. l+.us .. . _._ �.. ... ......... cri - _ z........_ -........................... Contractor's Name ..............'License # •----....,.............. Phone ................. .::......... ......•...................................................I....•- ----- installation will serve: Residence❑Apartment House Commercial oTraller Court E Mote!❑Other ............... Number of living units:...1........ Number of bedrooms A.......Garbage Grinder ..e...... Lot Size ............. .............................. Water Supply: Public System and name .--......--••-•................_....._........................_...............---.............._....:..._Privab Ea' I Character of soil to a depth of 3'feet: Sand 2;� Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam E3, Hardpan E3 Adobe❑ Fill M6terla! ............If Yes•hype............... ............ , (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slde.I .k .,NEW INSTALLATION: lNo septic - I ank or seepage pit permitted if public sewer is availaltifg,wlthin 200 feet,! � s ix •h . Uuid Depth � ""'""-" PACKAGE TREATMENT SEPTIC TANK; Size__...�. wx . Materidl.�©'M c^!.e.T�No. Compartments ----A............. Capacity . .... Type .-.-------•-- _ Distance to nearest: Well' .................. ... Prop. Line ................--- -- . Le tb"a azul Nile �" "" 'Total Length ....... . ....... , LEACHING LINE [ ] No. of Lines "d� .----• ng 'D' Box ._ _ . .. Type Fitter Material .Ir'!? :la:Depths Filter Material ..J.Y................../................... ' 4...... Pr Line . , Distance to nearest:-Well...�:.� Y foundation_.��.. w oE�rh► • t '[' ti Number .. ..... Rack Filled Yes [3 No 13 �.. SEEPAGE PIT 11 Depth ............... fliarr►eter� M.: Water Table Depth ...................... .. ......Rock Size . -- - Distance to neared........................................:foundation.' - :.. Prop. 'line ---- ................. REPAIR/ADDITlONIPrev. Sanitation Permit . :...... ...............••-••---•-•-;. Date .....................:..._...... .1 Septic Tank Specify itequiraments! `:'�..........:.......... ... ......... .......................... ................................................... ---..... -.... .................•. . . ..... ...........� . . .. . ._..,.'. Disposal Field (Specify Requirements) ..................•. .. ..................................................` ..................._....................._.........---................---.................................._..........................---...... ... --•................................................... ................ ........ ..`- (Draw existing a.nd.required addition on reverse side! ---... ...... .. I hereby certify that I have prepared this application and that the work will be dons In accordance with San .lear{uln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home 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 shoii not employ any person in such manner as to become 71s.�Co..' e.n..,sation #aw of aiifornia" ....---.... Ow Owner............................... .... . k ...... Title ...............1............................. of other than owner) ' F94 DEPARTME T USE ONLY APPLICATION ACCEPTED 'BY . DATE �. BUILDING PERMIT ISSUED .DATE ........................................ ..-••-•.................. . . ADDITIONAL COMMENTS ............................................................................................I..................... .. y ... ... ............................................. ... ...... .........._............................•-•--............ ........ ----' .... . .. . ....... . .. / 1 Final Inspection by: . Date ........;.-. rr.... .. .� EH 13 2h 1-,60 Rev. 514 SAN JOAQUIN LOCAL HEALTH DISTRICT $/?h 3M