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FOR OFFICE USE: 11 v -a 3a APPLICATION FOR SANITATION PERMIT __ �- `/ -..,3.j........................... ....�`I Permit No: - -� 5�7` - ... ..._... Date is (Complete 1n Triplicate) M. �. P P ) _ sued . ...... '��... This Perm(t Expires 1 Year From Date Issued "" Application ishereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicotion:�is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO '�.:...Z. ........ l . '-"•° _ ....CENSUS TRAGI Owners' Name ........ _ -� _ Phone.�f'. L-06I....... ... Address'................7,' �F' ........�- ............ .. .. City .': `: Contractor's Name ..... - k S93....... ..... .� •_.... ..... .... ._ License # . .. Phone Installation will serve: Residence Apartment House Commercial OTraller Court 0 M Motel [:]Other ............................................. Number of living units:..:...... Number of liedr"ooms .. •Garbage a Grinder ....: Lot Size ...Q....X..... .............:... Water Supply: Public System and name ............... ......I.............................. ••-•---............Y:. -. ................Private 0. Character of soil to a depthd'dof 3 feet: Sand b Silt Q Clay © Peat❑ Sandy Loam 0 Clay Loam Q .Hardpan p Adobe:0 fill Material ............ If yes,type ............................ (Plot plan, showing slie of lot, location of-system in relation to wells,1buildings, etc. must be placed on reverse side.) NEW INSTALLATION:, (No septic tank or seepage .pit permitted if public sewer is available within 700 feet') 3 ................ :....PACKAGE TREATMENT SEPTIC TANK Size........ .. Liquid De th Capacity .............. Type ....Material. - - -----_--_. No. Compartments ts Distance to nearest: Well ....................................Foundation .................. . Prop. Line ....................... ll. LEACHING LINE { ] No. of lines �..:...::....... Len th .of-each line.._:..._.._......._..... Total Length oa 'D't13ox•,. .._ ._.-Type Filter Material ....................Depth Filter Material g_...._._....._.................. p Distance to nearest: Well ........................ Foundation ....._.. ............ Property Line ........................ SEEPAGE PIT [ J Depth._............... ... Diameter ...........['.:.;.Number ..._..................y.a...� Rock`Filled' Yes 0 No Water Table Depth --•••-----•-=•••---•-•:.....:.....:.............Rock Size ----........_..:........_....-•p 4M Pro . Eine Distance to nearest: Well ........ ....................I............Foundation -:-----_-----_ ...:_:_......:........%A REPAIR/ADDITION(Prev. Sanitation Permit# ............ ..........................I... Date _................ ............ Septic Tank (Specify Requirements] ......:� :�..... ........... ....... ...... ........................................... . --------_................h Disposal Field (Specify Requirements) ....:-- ....._ � --=-`-i- - -•..................................................... << ------------ .. . --............................`f .._ .. ._.__. - ........:............_..._ ................................................... ........................................ •• ........ ........----•- ..----.................................. ...4.....s... I hereby certify that I have prepared this appltw ion�a d that atathe additionon will reverse side) M accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations.ofthe San Joaquin Local Health District. Home owner or titan- t sed agents signature certifies the Following: ` �> "I certify that in the performance of the work for which this permit is issued, I shall not.employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ............................... ��. ...... . ..... . -- Owner € .r ..... .. ` .Title ........... (If other th �owner) ,OR DEPARTMENT USE ONLY APPLICATION ACCEPTED B:F Y . �.--- - .............. .....................................DATE - � :....:...... BUILDINGPERMIT ISSUED 1..........................................................................._.................-----..___._DATE ..................:....................:... ADDITIONALCOMMENTS 'E .-•----••--------•------•..............•.... ......................:..........................................I........................... is ------ ,ice......................... ................................................... ......................................................................... ..........I.......... . .. . ...... . . ..... F ................. ................................. �..... ............... . ... . ......... Final inspection by. ... .. .. 'E ._ ....: ---•-.......I..........._...•..... •--•--Date .{ ...... ........... SAN JOAQUIN LOCAs HEALTH DISTRICT ;_mJ3 24 1L_,sa a-. �.,