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I FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r .................................:............. IComploh in Triplicate) Permit No. . ....._......................................._....... i ......................... This Permit Expirrs 1 Ysar From DoH Issued Gate issued- 0:. •. .7J - Application is hereby made to the Son Joaquin Local Heei;h District for a permit to construct and install the work herain described. ThI05pplicati6n is made in compliance with County Ordinance No. 549 and existing Rulos and Regulations: A �J� JOB ADDRESS/L ..ION O.. .7 4y01-4:'�l"�..AU..... . _ _. ...........CENSUS TRACT ........... .... Owner's Name ... .. .. .... . `}2C'.•'oTb"tp� ............._ Address ...... .. .......... �''�' ."+F.. .. Ctty 7�xf�' -a... . .. .. q Cantroctor's Name . . . «�L�1�f.Q-c/.. . .... .. . . ...Licensl all�'Ds/i ..-... Phone .. �i." l'.aI Installation will serve: Residence XApartment House[] Gommercfai'[•jTrailer Court Q Moto'0 Other !7.Pw�rS�'rJtca�-+ Number of living' Units,. %..., Number of bedrooms ...Garbage Grinder .......... Lot'Size ._ -. . .. Water Supply, Public System and name .. ........... �..e:......... .... a -................................Priwte� Character of soil to a depto h f31061: Sand o S!It C] Clay [), Peat❑ Sandy Loem Clay Loam r` Hardpan 0 - Adobe,❑ Fill Mcterial _...If yes,type....... ' (Plot.plan, showing size of lot, Iacaiion of system In relation to wells, buildings, ate. must be,placed on reverse sldaJ NEW INSTALLATIONt (No septic tank or seepage pit permitted if public sewtr is available within 200'feef,V PACKAGE TREATMENT ( J SEPTIC TANK[ •Size.:.. . ............................'. _._.... Liquid Depth` i' Capacity.._,._.. .......... Type .......... Material........._'....... ... No. Comportments ...................... Distance to nearest, Well ._-...............•::..............Foundatlop ........,........._i Prop.time................ ..... .;e LEACHING LINE [ J No. of Lines ...................... t.ength of each line. .. ....... Total Length ................ .......... — 'D' Box ...... _. Type Filter Mateiiisl ...Depth Filter Material I " i Distance to nearost, Well ............__........ Foundation _....._.......... .... Property: Line ........................ .+ SEEPAGE PIT O Depth _................... Diameter ................ Number ......................_�.. Rock Filled Yes Cj No (] ' .�:. Water Table Depth ............ .......................:.--------Rock Size ... ........ Distance to nearest: Well ____ ..................-,..Foundation . ._............... Prop. Line ................ REPP.IR/ADDITIONiPrev. Sanitation Permit# ...._... ...__. ........ ...._.......-Date ...._.... ...,...........J f _. 1 Septic Tank (Specify Requirements) - ....... .._........ ........... .... l... 3 .... _...-/1 ••••.r...'•........_.. Disposal Field (Sp, cify Requirements) .(QLKIX 'O'k '�•f/ -'••-'• - .. ... ... ....V . . ... .. ..................... _... .. iDraw existing and required additionbn reverse fide) 1 hereby certify shay I have prepared this application and that this work will be dens ie accordance with San Joaquin 'r County OmInc::ces, Stall Laws, and pulls and Regulations of the San Joaquin Local Health District.Hama ewnar or Ilsers. sed agents signature certifies the FaVowingr 1,1 csrsify that In the performance,o! the work for which th'Ic permit is Issued, I shall not employ any person in such monitor as to become subject to Workman's Compensation laws a5Califamlc.• Signed ...... . .... .... . .. ........Owner B .. .. . Title . . By �/'t (t"�.. ....�. ca (J.............. T other sh owner) FOR DEPARTMENT USE ONLY APPLICATIONACC EPTED BY.... ....... ._.:......_........... .................... ......... ....._...... ................ DATE ............................. BUILDINGPERMIT ISSUED.... .........................._ .............................. .......................................DATE......................................._.. ADDITIONALCOMMENTS ........ ..... ............ .............................................................._............................................................... ......•......................................... .........._............................... ..........._.........................................................,............................. ......... . . .... .............. .._ .... . ... .. .. ...... ......... Final Inspectionby. ...� . .. . . . ......... .Dat0.ff3. .t4.—Z........ .�. .. SAN' JO..QUIN LOCAL HEALTH DISTRICT E. H.9 1•'68 Rev.5M