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MR UFRU L15EI APPLICATION FOR SANITATION PERMIT .............. ....................................... (Cantplete In TripfiicatsT Permit No. ..7 ......................... ......................`... This Permit Expires 9 Year From Dale issued Dab Issued7.-2. .- Application h hereby evade to the San Joaquin Local Health'bistrict for a permit to construct and install the work/herein described. This application Is made In complianc 11th County Ordinance No. 549 and existing Rules and Regulations: .JOB ADDRESS/LO �TION ��,� { ti j .GENSU5TRACTOwner's Name .1.�: ...................... .......................................Phone ......................_.... ..._.. , R Address .........."... ...........:................h ,....... ......_._..Cit/ --------------------•----------- ........................................... ..License #��dA6 k.SL Phone x`10 Contractor's Name ------�?'-•-----•--- - -----=----•--•--•- �,��._.� Installation will serves Residence❑Apartment House JE) Commercial❑Troller Court ❑ Motel❑Other............................................ r Number of livingg units:_____..__... Number of bedrooms __�_____Garba a Gr n r ----.__..... Lot Size -------------------------------------- .L Water Supply Public System and name .._-• - --.................................................Private❑ Character,of soil'to a depth of 3 feet: Sand Ej Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom❑ i . . .r , F Hardpan❑ Adobe❑ Fill Material...._.----.-If yes,type.........:.:... ............ ' r __ -------. •�- � 'i ir,r �www�cwww�wrw�o �- r i --_-_ --- -- nuunimrir .4 (Plot plan,,showing size of lot, location of system .In relation to wells, buildings, etc, must be placed on reverse eide.l NEW INSTALLATlONa (No septic tank or seepage pit permitted, If public sewer is available within 204 feet,) PACKAGE TREATMENT [ 1 SEPTIC TANK f J Size::....._ ...... Liquid Depth -. // -••-•-•. ---•................ ............._•---... { t Capacity, .... _ - " aterial---._------ . .----- No. Compartments .-...�...:.......... ' # ; Distance to nearest: Well ..:.----:. . Foundation .. ..._ .... Prop. Line ............... • rLEACHING'LIN�E [ D No. of Lines ------------------------ Length of.each Ilne � �' � dotal Len�� .... � ._:................ r 'D' Box -F1_------ Type Filter Material ... ,_ _....Depth Filter Material ' .. I �; w • , Distance to nearest: Well , .. ..: Foundation': Ptopertj� Lln ....................... w SEEPAGE•PIT [ ] Depth .2.1•--------------- Diameter � _ . ;Number �....... ..... Rock Filed Yes ❑ No• 4. ' 1 Water Table Depth ` ' '° :i Rock Sit _--• --.__..--- ;{ y 4dt1` � • Distance to nearest:Well -_.:::�Wit..........::........•--....Foundation .................... Prop..Line ' • r ...... s..... REPAIR/ADDITION(Prev. Sanitation Permit @►.: r *� ..................... Date ........ ........ :- Septic Tank[Spedfy Requirements) ... r H _ -::-:c....... ... ....... �_. :. ..... .............-_- .... Disposal Fieia� Specify•Requiemeiits� . rtYa,��' ._.�� 1+:F:� :. -.." '"- f. ... (v.t ........... ...... .. .... .._. ' G (Draw existing'and required addition an reverse sidel I hereby certify that I have.prepared this application and that the work will be dons In accardanc'* with San 4*a4uln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Homs 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 beco,pmesub[act two Workman' Compensation laws of California." Signed .Lc s�� . .. . .... ...___.............................................. Owner 8y ........................... .................I.......�. ........................ Title ..................•.-•-••-. :......... ...................... } (if other than owner it FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . __..... :... ......... . .... ....... . ................ DATE :. -` 7.7.......: . .... . . . BUILDING PERMIT ISSUED ..........:..... ....: .......--•-•-........ ............... DATE'.. r::: .....:::__:w ..::..::....... ADDITIONAL COMMENTS ..................................... .................................................... ------•----•---•--- .................................................... .......................................................... ..... ....................•--•............. --- ...... ...... .-- •------- .........._..... . Final Inspection by: ..................... Date -- ........... •� .............. Mi 13 24 Nov. 5N N JOAQUIN LOCAL HEALTH DISTRICT $/7h 3M