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APPLICATION FOR SANITATION .PERMIT i y _ (Comptets In Trtpticafes - Permit No. } This Permit Expires 4 Year From Date Issued Dane lssuad Application Is hereby made to the.San .Joaquin local Health District°for a permit to. canstr ` and Install the work herein described. This application Is made In compliants with County Ordinance No:-5�9.6-nd exl:ting Rules-and_Regulationse k JOB ADDRESS/LOCATION 1. .. .._ . . .t.... :....... ..�.,.1.................•---............ ..CENSUS TRACT .......................... Owner's Name .... Yr... - ..t�.t. .. .�!�................... ....... ................. y � Phone ..._._ ate:....:......... City Address ........ iContractor's Name`1?Nh---- (10 ............................. ..� ... ............... ..License +� i2�..-�.�� .�.... Phone installation will serve= Residence[ partment House❑ Commercial[`]Trailer Court 0 Motel []Other ,- Number of living units=......-•.... Number of bedrooms . ......Garbage Grinder .. Lot Sin Water Supply: Public System and name t _...... ! . . , �•.�.... . ` »..................... .......Private[ - - --.- 0 Character of soil to a depth of 3 feet: Sand❑ Silt❑. Cloy Q Peat Q Sandy Loam Q,•_Clay Loam Hardpan Adobe Flli Materlol ./. :1f yes,typp............... ........... - F IPiot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATIONS (No septic}tank or seepage pit permitted If public sewer is available within 200 feet,} �1 I VACKAGt TREATMENT [ ] SEPTIC TANK ' e...._.. ,.l.... Liquid Depth ....W. ..........�f F Capacity .f�. .G..... Type .�ll ...4y hAatertal._ .... a. Compartments ....5��..-:.... .rVi t , D tante 'to nearest: Well fll 1-- foundation... :� Prop. 1. .. ..r :.! P Inc- iEACHING LINE No. of Lines __ -....... Length of each tlne..�, .. . „ .... iTotal-Len th- m.Z.2�.�......... 'D' Box { Type Filter Matetlol !.......Depth Filter IYlaterla! . . ... ......... N tante nearest: Well ....14 ....... Foundation .. ........... Property Elne ..,� r..............E . SEEPAGE PIT Q Depth ... �J21... Diameter .. �r Number .....---L, ............ Rock Filled Yes !o Water Table Depth _.._..... :r :r.......................Rock Size .. a.�.}(` ..`�..... . . Distance to, eIlearest: Well ;V ,,�� .foundation . .(?......... Pro Llne REPAIR/ADDITION(Prev. Sanitation Pemnit# ................... .. ��. k _.... • ... p• ..�. ...----� .peptic Tank (Specify Requirements} ..............•.............................................................f .Data ................... ........... .) D;sposol Field (Specify Requirements) .--•-•.................. .............-•---•........•---................................................... ..:: -- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application Fand that the work will be done Ii accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sari Joaquin'Lacal'Nealth District. Home owner or Men- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, I shall net employ any person in such manner as to become subject to Workman's Compensation laws of California." >gnec' ............ .. .�.........---•-..............•.._..---._...... Owner 14 By _-. e�r _�/ ...----•_.... Jitle ......... .(If ofthan owner] d ti FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY _. . ....... .. _ .' DATE . �0 '" G." BUILDING PERMIT ISSUED .... i _ DATE>.:................................. ADDITIONAL COMMENTS ... ..I.. .... ...................,..°. ... .. ..... ---------._.._.....--•-•• ......... ................ I - - •...................... ... �"--...-._.-. ........-................_.................... .. :..:..:.. .... ................................................. ..... . ............. !. &FAM114 .Final Inspection by: ..1� .LEH i3 21t I-erat4 }l°v• SAN 1tH ( R 3M [