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FOR OFFICE iJSI:: -3 , APPLICATION FOR SANITATION PERMIT `�yi .............. _ ... ......_...-- ........... (Complete€n Triplicate) Permit No/ ........................................................ ................................................ . This Permit Expires i Year From Date Issued Date Issued/.� Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is/made,in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...1. 7e_ �. f��...- •--... .. N Owner's Nome ...... -----• ---•-- .._.. Phone ..._:......_..._..._.......:...... Address �r �9o2�c---- - - - --- ---- --.....-------------.. --- .- -.r:-•- •----._._... City .. . : .....- ti``--.r-r--..�.�--P._-�.�------------------.------ ZZ) Contractor's Name .... i _ .�- = ".kieense # � �- & -. Phone .............................. ._ Installation will serve:. Residence [Apartment House❑ Commercial ❑Trailer Court ❑ ,/ ^ , )Motel ❑ Other ....... ... ............................... �3 Number of living units:.. j.... Num ber.of-bedrooms :=_�.rGabage Grinder .._ ...... Lot Size .......i Water Supply: Public System and name ..-. ----------------------•---_-.-•------.----------------•--•--._... ..------- ----_--.._..Private Character of soil to a depth of 3 feet:,I Sand ❑ _Silt❑ Clay Peat❑ Sandy Loom [:JClay Loam ❑ Hardpan ❑ Adobe Z/ Fill Material --•.....__.. If yes, 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 or-seepage pit permitted if public sewer.is available within 200 feet,) s PACKAGE TREATMENT [ } SEPTIC TANK I Size /'y 14./.,r. r'----._.-.-..-_ Liquid Depth ._,_ ...�............. t, .� Capacity ->!�o Type _ Material___. " �.. No: Compartments_ ............. f Distance to nearest: Well - �..�.................._Foundation ...I.9_k-r ...... Prop. Line LEACHING LINE [ No. of Lines'l. ...a. . . Length of each line ....:.�.�_�-�".._.:._ Total Length 'D' Box -1 - - Type Filter Material --------- 9.____Depth Filter Material ...J.I,.........,. Distance to nearest: Wel! .... .t-f... Foundation �::n --- Property Line _�.p.. ........ SEEPAGE PIT [>r Depth 6P_, .. Diameter _i.j r, Number -------. ............._.:.._ Rock Filled Yes &- No i❑ Water Table'.Depth ...----.._.. D-• ----------,...........Rock Size 2. .......... Distance to nearest: Well --------- .rA_. --------....- Foundation Prop. line ...7--r.f-1....._ I REPAIR/ADDITION(Prev. Sanitation Permit# --._.__.._...._--.--•--------------- Date _._....._.. ................... Septic Tank (Specify Requirements) k .. .. .......................... -i.......--------------------------------------------------_--------..____....... .-------- Disposal Field (Specify Requirements) ---•----------------------- -••------ - -- -------------------------- ..-............ ------ �i .................... .. ......... -••-- ............ - (Draw existing and required addition on reverse side) I hereby certify that I have prepared,this application and th at'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: "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 By . .. i ce ... ----- Title .-. ._... '......? (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY cl .......---- BUILDING PERMIT ISSUED ......... - DATE ....... ADDITIONAL COMMENTS ...............:.. ...... `.. t -----••-----•--•--.... _.-„ ...... . .......... .. ................ ................_..... ------------------------ --•--•- ----....._.. ............ ........_... . - ... _ .---._.._...... ....------•-- -•. --- .....__.......... i 5 ...__._-.InsI ..._....__.b .. _._. ................. ...... _....._.___._.__......_..... .. .._....._.__._.. Final inspection by .............. .--------------------Date.. ...... �. ., t - SAN 1O;4QUIN LOCA'L''`11EALTH .DISTRICT F_ H_-13 24 1_'hA Qnv SAA 7/792 H