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OFFICE USE: AIPPtICATLONf FOR SANITATION PERMIT Permit No. !•s• - -- ........................ (CompletelnTriplicate) w ._... ,..:.. 5� Date Issued r. yr ---• .......... ......••--••--...__..._........_• This pertnitExpires it Year From Date Issued ................... ....----...................... struct and install the work herein Application is hereby made to the Son Joaquin Local Health District for a permit to con { described. This application is made in compliance with County Ordinance No. 549 and existing Mules and Regulations?- '. ......................:CENSUS TRACT c�..7._ . JOB ADDRESS/LOCATION - ---Phone Owner's Name ----- .,------- -- --- L g .................Cf Address _.. 2 -•----- ..... --- 7.`1 .1.... Phone Contractor's Name ._.. _ •---•------------------- --..License #. i Installation will serve: Residence Q Apartment House f] Commercial QTrailer Court Q ,. Motel nth -------------I............ Lot Size ........._. Garbage Grinder ....--_ .... -••......................•...__.. Number of living units------------- Number of bedrooms --._..•...-- 9 ........... . .......... ...Private Water Su I . Public System and name - pp Y• � Cloy Peat❑ Sandy Loam.[] Clay Loam tl . Character of soil to a depth of 3 feet: Sand❑ Silt Q y ❑ Hardpan❑ . ......_. Adobe Fill Material ....if yes,type ............... ....... �. . . shov+in size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.l (Plot plan, 9 04 feet,j i permitted if blit sewer is available within 2 NEW INSTALLATION: (No septic tank or seepage pit p Liquid De I SEPTIC TANK ] Size._..,� ..........................-•- No. Compartments PACKAGE TREATMENT I ] -----••.-•-.......... .��-o-d---- TYi� r'GMa#erial.---�•-•---•---•--•--- � Capacity -- .._. . - -- DO Distance.to nearest: Well ............. .... _Foundation .. ..... Prop. Line ..............:....... J ._.� ._. Length of each Brie.--.....�Q- .,....... Total Length :�.................. LEACHING LINE [ ] No. of Lines --. ......•--- De Depth Filter Material •.-.- /.�f--.....--•-•..................... l 'D' Box _.... ---• Type Filter Ma#erial .. (.--- p. -ii._.. Foundation .................. Line ........................ Distance to nearest: Well ................ "Number Property p �y Depth ._..�-��--- - Diameter .� �•''�� Number ...----. 3................ Rock Filled Yes �/No 0SEEPAGE PIT [ ] P ( -------- Water Table Depth ...Rock Size ................................ f Distance to nearest. Well �•- ..Foundation . Prop. Line ........... -•.••......IE REPAIR/ADDITION(Prev. Sanitation Permit ----------------------------- Date .f.....- .: m ....... ............ _...._.... -..._.__ Septic Tank (Specify Requireen#s� . --••---••-------- Disposal Field (Specify Requirementsi ....... •-• -------••-------••-•------------ --•-----. -------- -------------•---------------------------------------------.......................... ............................................. . - (Draw 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 JoaquinCan, d Regulations of the San Joaquin Local Health,District. Home owner' or County Ordinances, State Laws, and Rules anll sed agents signature certifies the foilowing: l person in such manner "I certify that in the performance of the work far'which this permit is issued, 1 shall not employ any as to become subject to Workman's Compensation laws of California." Signed _..--•---------•-••-----............... Owner ..:_. Title (If other than o er) FOR DEPARTMENT .USE ONLY ATE . . ' /S f - .DATE ,,'-�y --•------- APPLICATION ---- - APPLICATION ACCEPTED BY .-- - --,---- - --�; -� �� .-----------------.........__..__. BUILDING PERMIT ISSUED _.�. �•--------r--------------•----•--- �/ I ADDITIONAL. COMMENTS -.1 �� .3.�.2J.._.._aE__,!?O�V "Af..2�A-J*_4-0_40, a - ---------- -------------w-__ -- -------------- ---- •-•-•-•............ _...._. ....... -•.... ...-----•......-.. --- Final Inspection EH 13 2h 1-6ti ite'v. 55M SAN JOA UtN LOCAL HEALTH DISTRICT 8/7h 3M I - -