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FOR OFFICE USE: • APPLICATION FOR SANITATION PERMIT ......... .... . ... _.--_• (Complete in Triplicate) - --•-•............. .......•- Permit No. .:7.._._..._... .- _ This Permit 1 Year From Date issued ` it EDate Issued ...........:.. Application is hereby made to the?Son Joaquin Local Health D int for a permit to construct and install the w described- This application is made in compliance with County Ordinance No. it t and existing Rules and Regulations: i work herein J08 ADDRESS/LOCATION Z9 s' . ..w.;�6,...,__•A-c�,,-QN.�_Qt- u..�/� . _ �I• ...;_- C N5US TRACTOwner's Name ... Address ..._._. ,. ...._.._. ----• - � ._._..... ..--- City Contractor's Name > is ------- •...................... l -_..License #.: . .. q Insttrilo ion will serve R a� ,� Phone " Residence [Apartment House-❑-Comm ❑ railer°Co rfi ❑ r _ `.. c l t Motel IE]Other-'~ --- !..-_. Number of living units:....-- Number of bedroorns�.3 r ,�s Water S�pply:,PGblicSystem and'nam` _: - . Carbage.Gririder ;--- ....._ L'ot,Size ...- -+�,�[ _..--•----.. Character of soil to a depth of 3 feet: Sand[��- Sit 0 Ci a Peat -• -------Pri cite y + Sandy Loam E] Clay Loam' Hard ani F. t p ❑ ' obe ❑�F;li1�ter;ial .[ .-.. yes, type . d If (Plat plan, showing size of. lot, location of system n relation to wells, buildings, etc. must be tweed —on—'reverse i NEW,I____ ATiON: (No septicit or seepage pit permitted if public Sewer is available within 200 feet,) everse aide.) PACKAGE TREATMENT [ SEP.TIC TANK Mf ) Size----... .. .................... b4uidrDepth ..___.. .. , ) Capacity ._ , 1 _.......... Type --- Material.- _.. . No: Compartments - �. Distance to -nearest: Well .....__......... .... .--- W LEACHING LINE ........,.._ Prop. Line ...................... ; [ j No, of LinesLength of each line oun anon-. ....._ Total length ._. _- 'D' Box _._..,- .. Type Filter Material ._---__-_. -,� �- S U Depth Filter Material _... ...__.---•---..__.._- Distance to 'nearest: Well - Foundation SEEPAGE PIT ...... ............. Property Line ; E ] Depth Diameter ........ ....... .Number l t` Water Table. Depth ....... Rock Filled Yes ❑ No 0 r _.._-..__. 4 ------------ Rock Size ................................ Distance to nearest. Well ................. . .. ' Foundation _ Prop. Line .._-.............. _ REPAIR/ADDITION(Prev. Sanitation Permit# ................ --•------- Date ( Septic Tank (Specify Requirements) , P - Disposal Field (Specify Requirements) ------------- ................. r --- _._..__,......, ------ -- ----- -------- ............. -------------- ---- _ (Drdw 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 Joaquin 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: "t certify that in the performance of the work for which this permit is issued, i shall not employ an as to become subject to Work an's Compensation laws of California." p y y person in such manner Signed ....... ................................. ----. ---------- Owner (if other than owner) Title .... .. FOR DEPARTMEN USE ON Y APPLICATION ACCEPTED BY ................t-....--_-, BUILDING PERMIT ISSUED : ............ - DATE __..._�-. a' _..._......_..... ADDITIONAL COMMENTS .................. ---- DATE - -- ------------- .....• •....... ------.. ... -- ......._.....- --.._ .----- -- ....................... .................-.__. --- Final Inspection by: ... -- Date ......eL tW,:?�........... SAN JOAQUIN LOCAL, HEALTH STRICT �