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rvx UrrIc�c tl5t:: APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No.�-�;.ft•Y — ...................... .................................. This Permit Expires 1 Year From Date Issued Date Issued/..�?.a?} 5. Application is hereby made to the San Joaquin Local Health District for a permit to'construct and Install the work herein described. This application is made in compliance with County Ordinanc No. 549 and existing Rules and Regulations: I I (2-k w.-, ��. JOB ADDRESS/LOCATIO �l _. ._.. _ . .. .--- I*rf e I ----- -. LT j{�..CENSUS TRACT ....... . ... .. . j� �F _. - Owner s Narita ........... ..... ........ . ...._.._. . ..... . .. '.... ..........Phone .:. . ......... Address ... t......................................... City ...r .G z ------.......----- Contractor's Name .....------•--• License #�s.�.3`t Phone 060........_ ................... Installation will serve: Residence dApartment Houseo Commercial ]Trailer Court 0 Motel 0 Other.................. Number of living units:..._( Number of bedrooms 3--...Garbage Grinder lot Size x 3DB ...... ................. Water Supply: Public System and name ....................... Private 0 Slit 0 .Clay 0 Peat 0 Sandy Loom 0 Cloy Loam ......................... Character of soil.to a depth of 3 feet Sand Silt 0 Hardpan Adobe Fill Mnterlal ............ If yes, type ............................ (Plot plan, showing size of lot, location of system in relation to-wells; buildings, etc, must be placed on reverse side.) N NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet) °Q r r� PACKAGE TREATMENT SEPTIC TANK.[ j Si�•��5�...X-• � " n ---•• •- �-•.................... Liquid Depth -�� Capacity .[ c�._._ Type .1 _.... _... Material...�-a:.r..f.�---. No. Compartments Distance to nearest: Well JA"'I` .................Foundation !4.............. Prop. Line it G LINNoof Lines .._.. .... Length of each Iine LEACHING E . ...._� ..... ..,,,W.. •............... Total Length 4;.s°1.................. 'D' Box { --�.••.- Type Filter Material .904..__.__Depth Filter Material ..................... Distance to nearest: Well ........... Foundation ° f• Property Line ' � Q......... , SEEPAGE PIT Depth ._., 5...._. ... Diameter ..3, __..... Number ._ - . Rock Filled Yes �f No 0 � Water Table Depth p ......................... -------------•-•......Rock Size �!�'� /y0 / e Distance to nearest: Well ............... Foundation .--1P -_t..... Prop. Line s . REPAIR/ADDITION(Prev. Sanitation Permit# --------------- - ..... Date ) Septic Tank (Specify Requirements) ................ Disposal Field (Specify Requirements) ----•-•----•--••----•-•-••.................................•....-----....----................ (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner of licen- sed agents signature certifies the following: J "I certify that in the performance of the work for which this permit is issued, 1 shall not employ as to become subject to Workman's Compensation laws of California." p y any Person in such manner Signed .................... ..... ...................................................... Owner BY ......... Title ...................r ....__. (I oche t an owner) FOR DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY ........... .. r ......--.-.•_-- DATE _... BUILDING PERMIT ISSUED ................... ADDITIONAL COMMENTS .... . / .G$` .dC. c „f ........................................ ...._- ....._....................... DATEr....................... ................I................I.. .......•.............. Final Inspection by ..,.-............... ............Date ./ .... .................. SAN JOAQUIN LOCAL HEALTH DISTRICT