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FOR OFFICE USE= APPLICATION FOR SANITATION PERMIT Per+rit No. .:................ ... --•---. .. (Complete in Triplicate) _......._. Date Issued - _ This Permit Expires 1 Year From Date Issued rei ereSan Joaquin Local Health Distri rdinan a permitfor 0 Application is hereby o. 544 and existing Rules t ainl the work d Regulafi ons- n Y made to the described. This application is made m compliance with Count y CENPh 5 TRACE-..................... I )133 -•- . .-Phone ADDRESS%LOCATY r .... �6 .f Owner's Name ....... .. . .... ....... - •- ----------: City ......... .................................... Address ... # . � .3 � phone ` . •.... . License .... Contractor's Name Commercial []Trailer Court Installation will server Residence Motel Apartment .. - ❑ i `� artment House i Garbage Grinder ----......_ Lot Size ... ....... \ Number of living units:.. -------.:- Number of bedrooms .._. _ Private i �- ---• -- •---- - "v Water Supply: Public System and name .................. .. . ... . . . _ -- air❑•--•• - - Sandy Loam'❑ Clay Lo _ Silt Cloy ❑ - Peat❑ = r � Character of sail to a depth of 3 feet: Sand ❑ Adobe a ........................� Hardpan Fill Material I yes.type _ �_� __ - - - - laced on reverse side.) a showing size of lot location of system in relation to wells, buildings, etc.,. must be p (Plot .p P p ewer is available within 200 feet,) NEW INSTALLATION: . (No septic dank or seepage p p ' t +t ermined if public s. .. .. ....... ... Liquid Depth .___._...._...._... SEPTIC TANK ] Size----------------------------, .. y _ .. ... Type No. Compartments Cdpacrt Yp Fo PACKAGE TREATMENT .................... N4at�idl._. .. Pro Line ......•-------.....�-- undo Length ._... Distance to nearest: Wel .w , LEACHING LINE ( J No. of Lines .. .. of each line ..: .. Total Length _...._.__.----------... t e Filter Material ................:.`Depth-F;Iter Material ------- •D' Box .. Type - Property Line .----------------• -- v Foundation N Distance to nearest: Well ...............:........ NiJrTiber Rock Filled. Yes ❑ -. _, - SEEPAGE PIT [ ] Depth . - ... ... .- Diameter Water .Table Depth Rock Size ................................... _ _____ Prop. Line .._.._.. ... Distance to nearest: Well -- . _•-" _ ..:Foundation , + Permit# .....- tl7ate - REPAIR/ADDITION(Prev. Sanitation Septic Tank (Specify Requirement) _. ......... .. .._ ...... .............. Disposal Field {Specify Requirements) .. r - ---- -------- - ...---- ---. +(D rami existang and required addihan on•reverse side) Nefw`�rk III be done in I hereby certify. that I have preparet{,this application t,o`nsnd that oFtlie San .loaquin Local Health District. Ho e o nes or [cance with Son . I County Ordinances, State Laws, and Rufes and Regula sed agents signature certifies the following: person in such manner kW certify that in the performance of the work for which this permit is;issued, I�shall not employ aril► mpe - • as to become subject to Workman's Cornpensatiod"laws of'Cn ifornial ►` � o w owner Signed .... ..�.......... ............ .......... . ........ . + .�. •� .__. Title ...... By (If other th n owner) FOR DEPARTMENT USE ONLY __ 73 - _ = —— J•. DATE .. .... . ".- .. ..:............. APPLICATION ACCEPTS B _._.... • DATE _ .._.. ---...._._.�- ----------------- 4 -------- -------- --..._.;-._..._...._._....--- BUILDING PERMIT ISSUED ................ .................... ADDITIONAL COMMENTS ...... ------- ----------------- ------------------------------ •-.- ---- .._..._.....,. ---- ... , } __................- ._: - ._ .- ...___--- �._. - _ _ :� :.........._......... .............. ... ......._...-.` Dote ,'k Final y: .. Inspection b .................. %. . p r -SAN-:10AQUIN' LOCAL HEALTH DISTRICT 7/723%