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FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT .. ri .... i ..................•---•..... x (Complete in Tepileah), permit No. _ .:... . ................._......_........-:......... r ,.. _. _ ............... _.......... This:Permit Expires 1 Year Fro' Dah lssaed Date Issued ,� =,2 Application is hereby made to the Son Joaquin local Health District for a permit to construct and Install described. This,application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- JO JOB ADDRESS/LOCATION �i i ^/ SUS TRACT r - ._.. Owner's Name ..... a. ._..--_--.. 17.PVA./� . ...... ............................ .........Phone Address ..Si .............i........_ --•-------....-•••---•-------•-......:City Contractor's Name �I�7- _- ,} ---••--#----- -----....License#` Y ----------------••-•--------...--•--........_.. - -•---- -• ----....---- Phone -----_---------------------- Installation ' will serve: Residence Apartment House Commercial.p r fl ❑Trailer Court ❑ t, Motel ❑Other..•-•-•-•---••-•-•--•----... ... Number of living units:....-...... Number of bedrooms .___...._,--Garbage Grinder ...__....... Lot Size ...........---------------------------------Water Supply: Public System and name ...._ . _..�•--....................�..._ � � .........-....................................Private ❑. Character of sail to a depth of.3 feet: Sand b Silt❑ Clay ❑ Peat❑. Sandy Loam ❑ Clay Loam ❑ Hardpan `�. pan ❑ Adobe 0 t=ill Mcterlol ...._....... if yes, .s type••-•........... ............ (Plot plan, showing size.of.lot, .location of system In relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: {No septic tank ar seepage pit permitted if public sewer is available thin 2Q0 feet,) 9 PACKAGE TREATMENT ( ] SEPTIC TANK l Size. ...................�.----..._--•-----... Liquid Depth ........................... 'x/5`T/IV d' Capacity Type Material..____._. No. Com Distance. to nearest: Well - --.._Foundatio --••--------- ._ Prop. Line _ LEACHING LINE No. of Lines _...'�----•---- -•--..._._ Length of end/ .� e..-".]:d_..... tat Len 'Q' Box __........._ Type Filter Material�_Depth�itter atonal ~�-Distance-to~nearest:TWell �7. _ _ „� q . '"`''"fc�utidat7o . ---- --. ro ep rty L ni a `.. SEEPAGE PIT O Depth . ------ Diameter :_...:3...-•---- Number ..................•- • - +"� .. !tock Filled Yes ❑ 4No � Water Table Depth ................... ...Rock.Size Distance to nearest: Well Foundation _ ............. Prop. Line REPAIR/ADDITIONSanitation. Permit pate .. (Prev.l = Septic Tank (Specify Requirements). - Disposal Field (Specify Requirements) ....................... 1 L .......................................... _...__---_____ -�-�. -- ----------- -- .......---•-..----^.. .........:........ ..........•-......... ---•-•---•- (Draw existing and required addition on reverse_side) 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. No's owner or lieen- sed agents signature certifies the foWw;ng: ".I certify that in the performance of the work for which this permit is issued, I shalt not ' to as to beca7e subject to Workman's Compensation laws of California." employ an y person in such manner -----•--- -- Signed _ -------. Owner I o By .. --------------------- Title f ther than owner! _ FO EPARTMENT U E ONLY APPLICATION ACCEPTED., BY _ - ... ..... • DATE _.... -.�.o:-. _�`.__..: lLDING PERMIT ISSUED . - _....._.. • --•-- ADDITIONAL COMMENTS -- ,j. ::_.. ------.._DATE ................... --- ... �1 ---------- -- .---------•------------- ---------- ........................••------ Final Inspection b ---------•---••-------•--•----_....... ..--- -................. . _ p y: .. Date -. �... . EH 13 211 1--613 liev. ...j�.... ......... SAN J(JAQ�l;N LOCAL HEALII-1 DISTRICT 8713 3M