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FOR OFFICE USE: .......... ....................................... APPLICATION FOR SANITATION PERMIT 7 _�I� !Complete in Triplicate) Permit No. ..................... ............................. ...................•-••--..-_......................... Data Issued /a ...:........... This PennitlExptres 1 Year From Dote Issued •-•------------.._.. I 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 lin compliance with County Ordinance No. 519 and existing Rules and Regulations- 7-7 egulations:o u s� -- --C S TRACT.. .... .rY!-.JOB ADDRESS/ OCA ; pone � jOwne �_= r's Name ------ p J Address -,;_....... E �`�-•- __ 0210, vl�c .l. .. y" ...Ci 7 t-l'. :� � a Contractors Name 2--f✓f �--- -- ��. ._._-..License � jf:...--- Phone V. -:/6 -• ��_[_-- 6 - Installation will serve; Residence Apartment House 0 Commercial❑Trailer Court 0 Motel []Other__ ............................... 1 Number of living units:-1-~_... Number of bedrooms ____ g ---------------------------------` G,•Garbp a Grinder ..:._....... Lot Size - ......� Water Supply: Public System and name _._.... --...-•--------------•---- ,-••--.f _ - .............._,__...................Private Character of soil W depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom Clay Loam r . R Hardpan Q Adobe ❑' Fill Material ............ If yes,type............... ............ . i. . r f (Plot plan, showing size of lot, location of system' In.-relation to wells,_buildings, etc. must be plated on reverse side NEW INSTALLATION: (No septic tank or seepagept permitted if.public sewer is available within 240 feet,) PACKAGE TREATMENT _(_I_ SEPTIC TANK-I,I Size__,........................:.................... Liquid Depth ---------___-_-_---- Capacity -------------- Type ____________________ Material----___-_____:•----_-- No. Compartments ................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE ( j _ to.-of,Lines_____ ____________________Length of each line-------------------------- Total�Length .--_---.__-_______-------_ D' Box Type Filter Material ....................Depth filterMaterial .......................................... -- Distance to nearest: Well ........................ Foundation ................. Property Line .................... SEEPAGE PIT ( ( Depth -------------------- Diameter "T_' "7r..`__ ``Rock Filled Yes ❑ No WaterTable Depth ................_...............................Rock Size -------------------------------- Distance to nearest: Well":..__ -------------------------------------------------------Foundation ----•...____........ Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# .........-........................ �......�.. .................................. Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) 0 ,,rr�yy ....... -� .._._ ___' ,---•---•--••-------- -----•-- ----------------------------------- ...........................................................---•-..................... -----••---------------- --------------------------------------•----•------- -------------------------- .........,..........................................-.-......-•-------•--•---.......•••- (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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Hoene owner or licen- sed agents signature certifies the following.- "I ollowing:"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 .............4_---------- =� -------- Owner By _..._._.__ ----- ---------------------- ---•---•------_ Jitle ....---------- (If of r an owner) _ FOR DEPARTMF-NT U5 ON! APPLICATION ACCEPTED BY ------- ---------------------- --- ---- ----- ---- -- ------ ---- --- - --.--=------ DATE _.l :�-7