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FOR OFFICE L15E: APPLICATION FOR SANITATION PERMIT --------_. .t•.................. .................... . ". Permit No. ... (Complete In Triplicate) This Permit Expires I Year From Date Issued Date Issued Application is hereby made to thelSan Joaquin Local Health District for a per to construct and. Instal[ the work herein described. This application is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations: JOB ADDRESS ONsctF7r� ...F..........CNSIS TtAC ... Owner's Name . 11114c.'r .......................... .Phone ............. ..................._ . 20. .......•....CitAddress ...... . ........•....._.._ ............ Contractor's Name ... License # Phone Installation will serve: ResidenceK.Apartment House Commercial❑Trailer Court 0 Motel ❑Other ---- --------------------- --------------- Number of living units:...._.... Number of bedrooms ......Garbage Grinder ..... .— lot Size a Q-?oZ x...................... Water Supply: Public System and name .-- ..............................................._..............I...........................:..._.....Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loan 0 Clay Loans ❑ HdMlYon-o—AdobeX`F'11-M6terlat".).......... If yes,type ' )Plot plan, showing size of lot, location of system in relation)to wells?building fetc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit ,permitted If public sewer is available.within 200 feet,) i PACKAGE TREATMENT j ] SEPTIC TANK; ] Size;;.................. •-•-------.. ............'. Liquid Depth .......................... ' Capacity .......... .-------- Type ---------- .. Material . No: Compartments .................... "Y' f'5 Distance.to nearest: Well ................. r ..... -•------•-----•--:.Foundatio"�1'. - .........._ Prop. Line ................. .1 ;11. t , r LEACHING LICE [ ) ..No. of Lines ------------------------ Length of. each line.:_..... � � Total length ............................ x." D' Box ..:�..:..... Type Filter Material .. ......... p ..Fi l� -. ....... _ De th Fi-ter Materia.. .......... .. . �X pistance to nearest: Well -.....................�. foundation � t i PropertyLlna. ............. ... SEEPAGE PIT fie th _� .-_.-___ Diameter _ t 1 ) p -to r .____.. Number'r.. _.��-....... .'.. Rock Filled Yes No ❑ Water Table Depth ------. .�-------- -------_--------------Rock Size- , !✓ Distance to nearest: Well --_, Foundation.........•---•' Prop. Line ........ t REPAIR/ADDITION(Prev. Sanitation)Permit# ..........................._....__•--------- Date ____. ................._......) I A ,. ` )-t-rrv' Septic Tank (Specify Requirements) ...:.. ................. ---------------------------------------------------------- D' of Field (Specify Requi erinents) J• �`�.-�-_ ................... ' 1p.... ...... (Draw existing and require'd�addition on reverse side} ! hereby certify that I have prepared this Application and that the work will be done In accordance with San .4edquI { County Ordinances, Sta a Laws, and Rules and Regulations of the Son Joaquin Local Health,District. Home owner or licen- sed agents signature certifies the following: "I certify th in the performance of the work for which this permit is Issued I shall not.employ any person In such mann kas to becoa able t t War an Compensation laws of California. Signed -... •--------• .. ........ - Owner By ------------------------------ -- -- -- -•-- - - - -- ................... Title ...... ------- ------ -------------------- (If othe an wner) F DEPARTMENT USE ONLY y APPLICATION ACCEPTED BY ... ... E -- - ------------.......•• ..................... ......--•.............. DATE , Z .. ............... BUILDING PERMIT ISSUED ---------------------------- - .............DATE --..... .............. .................... { AQDITIL CO ME TS - �Je �[ �' j �O . .... ... . ......:............ final Ins ection b r_-.._-- -" �. ........Date y :. 13. .................. . EH 13 2I: 1-68lav• 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8 7!I 3M r s