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VMW ..► FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. ..... . .. . .. .. . Permit No. -.7 ••--.253 ..... - � •� � (Complete in Triplicalo) . ........ ............................. Dote !ssued This Permit Expires 1 Year From Dote Issued Application is hereby mode to the San !cagvin local Health District for permit to construct and install the work herein described. This application is -node in compliance with County Ordinance No. 544 and existing Rules and Regulations: �/ CJp .... . ............ ......CENSUS TRACT)kA .. ........ JOB ADDRESS/LOCATION _�C•YJ.Id tA•/../..- . Owner's Name .. .LU.Q.Q�1... ................................................. C _. c /J � ........_ �Qtl� .,...AI .....................City ......./`ri=.- Addressu ...r;t.. . :. �� ... ........... ..s ±�......................License # .... 7... .../... Phone'................ Contractor's Name .��. .c�jQ?S..-rte../..�/� .: . ial QTraller Court Installation will serve: Residence Q Apartment House Commerc Motel Q Other ........................... rr • Number of living units:............ Number of bedrooms ...L........Garbage Gr!nder ............ Lot Size .................. .......... ....Private Q/ Water Supply: Public System and Home ............................................................................_........... Character of soil to a depth of 3 feet: Sand Q Silt Q Clay Q Peat Q Sandy Loam Cloy Loom [3Hardpan Q Adobe C] Fill Material ............If yes,type............................. showing size o. lot, location of system in relation to wells, buiidings, etc. must be paced on reverse side.) (Plot plan, 9 NEW INSTALLATION: !No septic tank or seepage pit permitted if public sewer is available within 200 feet,) SEP i IC TANK[ J Size... ....... Liquid Depth .......................... ' PACKAGE TREATMENT [ ] V topacity ........ ........... Type ...... ........... .. Material...................... No. Compartments ...................... Foundation ...................... Prop. Line...................... Distance to nearest: Well ................................ ... Length of each line. .................... Total length LEACHING LINE [ ] No. of Lines . .......... .................. 'D' Box ............ Type Filter Material .........Depth Filter Material ...................�....................... ! operty line Distance to nearest: Well ........................ Foundation ..... ._................,. Number ............................ Rock Filled Yes ❑ No ❑`^ SEEPAGE PIT ( j Depth Diameter •- --•-• ................Rock Size ................ _......_..... Water Table Depth ......................••• Distance to nearest: Well .................................... .. Prop. line .................... REPAIR/ADDITION(Prev. Sanitation Permit# ....................... Date ..................................I Septic Tank (Specify Requirements) ------.-• --••••••• " Disposal Field (Specify Requirements) ... •�(Lr••_•`t-• -�t '� �-Ltl�• ----�................................... ... .................................. ..... - .. ••.-.. .•• (Drew existing and required addition on reverse sides cation and hat he work will be ne In accordance with Son Joaquin IOrdd certify ces,t Stale Laws,pand Rules and 1 Regulationstof the e I have prvared this e San Joaquin LocalHealtF+ District.Home Owner or 1 cen- Coununty ty sed agents signature certifies the following: arson In such manner "I certify that in the performance of the work for which this permit is issued, I sho.l not employ any P as to become subject to Workman's Compensation laws of California." ..... Owner Signed . . .. .. . '....... ..................................... .......... Title . B y� . ....................... ............................... C'<Cit-Gam..... ..... FC...`.. By other than owner) FOR DEPARTMENT USE ONLY — _�_ -- r' DATE ..f.. ../.. . ... . . DATE ............ APPi1CP.TION ACCEPTED BY .....�.:. .......................................... BUILDINGPERMIT :SSUED ........................�. ..........................................- ...... .....-............... .........................._........................ ADDITIONALCOMMENTS................. ................. . ............ .... .......::-'........................................................................_..-.........._... ................. . ....... ...... ........... ................. ...................... ..................................................... ............. ... �.... .. Date f ••- ............ Final Inspection by: ......Z .�. -- SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723m H.1: 24 1.-68 Rev. 5M