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FOR OFFICE USE: E - APPLICATION FOR SANITATION PERMIT ---------- ----- (Complete in Trip .licate) Permit No. __._ 7 -1-L/ ------------- This Permit Expires 1 Year From Date Issued i Date Issued 3�_ �_- Application is hereby made to the San Joaquin Local Health District for a permit .to construct and install the work descdibed. This application is made in compl' nce ith County Ordinance No. 549 and existing Rules and Regulations: . � k herein 1.09 ADDRESS/LOZN __�r�33 y / _ - CENSUS TRACT Owner's Name •- -. _-_•_ G� ` -y- ,r7----------------•-------_ ---------_Phone .--- Address d_-r` �f . . . = - Contractor's Nome city -------------- ----•--- - License # � j.¢`�'. t Phone ------•------ {installation will serve: ResidenceApaiyment House❑ Commercial j]Trailer Court ❑ Motel ❑Other----- Number of living units:-------'--- Number of bedrooms _._____Garbage Grinder _______F.. Lot Size ___ _ Water Supply: Public System and name ---------------- -- - ------- ----- ------ Character of soil to a depth of 3 feet; Sand ---- Private [� t ❑ Silt.[} Clay ❑ Peat❑ Sandy Loam ❑ Clay.__Loarnj Hardpan 'TT P ❑ Adobe Fill Material ------------ If Yes, e-------------- fPlot pian, showingsize of lot, location of system .in relation to-wells, buildings, etc. must be placed an reverse side. �EW INSTALLATION: (Na septic tank or seepage } pit permitted if public sewer is available within 200 feet,) C ,:.PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size--------------------------------------------- I� • Liquid Depth -•--------------- Capacity�# p tY - Type -------------------- Material--------- -------- No. Compartments ------ ----- G l '= Distance to nearest: Well ___________ __ <.LEACHING LINE ----------------------Foundation Prop. Line ---------• = i [ l No. of Lines ------------------------ Length of each line----------- -_-- ---------- Total Length n I FD' Box _._..-___-•- Type Filter Material - -------Depth Filter Material Distance - - - .._• ' to nearest: Well ----------------- ` ---_-- Foundation --.--•------ ----------- Property Line � I FEEPAGE PIT f } Depth - ------------•-------•--- Diameter----------------- Number ----------- Rock Filled Yes ❑ No -ID Water Table Depth ------------. ------------------- - ...... Distance to nearest: Well Rock Size ----------------------- � ____________________ __ Foundation ---------_- 'PAIR/ADDITION{Prey. Sanitation Permit# ---------------------_ Prap. Line -.------------- t,+ Septic To (Specify Requirements - --- Date ...................------- Se _ } ` --------------------------•------------•-------------------- --- osal Field (Specify Requirements] _ Ze ----------- -- --- -- - ------------- ----- ----- ---- ----- --------------- ---- ----------- - - -------- -- _ � . -------- ---.: Funty (Draw existing and requi addition on reverse side} hereby certify that ! haveprepared this pppJication and that the worfc wil! he done in accordance with bOrdinances, State. Laws, and Mules and Regulations of the San Joaquin Local Health District. Home Whey Joaquin sed agents signature certifies the following: certify that in the Performance of the work for which this f F� permit is issued l shall not em fo an s to become subject to Workman's Compensation Jaws of California." p y y Person in such manner ' i Signed --------- Owner i _ Title - -r -� (If other than owner} a COR .DEPARTMENT USE ONLY 'PLICATION ACCEPTED. 8Y _• ocJILDING PERMIT ISSUED_____-_-'-- ---___--- ------------------------- - DATE - - ADDITIONAL COMMENTSF - 11----- ----- ----------------------------------DATE --------------------------------* ---------•--------------------------------------•----------------------------- ---"I------------------ ----------------------------------- ------ ------------------------I -inal Inspection b ----------------------------------•------------------------------------------- ------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT ----- i Y i ' h