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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT 7 — ...... (Complete In Triplicate) Permit No. 7...... .......... 3L-v's -77 ....... ............. ............................. This Permit Expires I Year From Date Issued Doti Issued ................ I Application is hereby made to the Son Joaquin Local Health District for a permit to construct 7 and install I the work herein described. this application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION �6,3661�� /�- e 14?J , I fl, <......I.,.......... ............. CENSUS TRACT ........................... Owner's Name ...... ........ ........:_,..............Phone "90/7/e,Coo..... Address . ........... .... ..... ........_....... ......... city .... ..................*................................ Contractor's Nome ..................License #257q.,50... Phone Installation will serve.. Residence IX Apartment House f] Commercial OTra;l*r Court C] Motel E]Other_..k ......................•--•....... Number of living units:.....I------ Number of bedrooms .0.....Garbage Grinder ........ ... Lot Size Acep-19.41<........ ...... Water Supply: Public System and name ...... ...............I...............I.................................. ........................'Private Character of soil to a depth of 3 feet: SandE] Silto CIaY0 PeotO Sandy Loam o Clay loam m I Hardpan 0 >Aclobe 1$ Fill M_ terial ....... if yes,,type....I....................... (Plot, plonjshowing size of lot, location of system' in relation to wells, buildings, etc. must be placed on reverse slclelk\ NEW INSTALLATION: (Na septic tank or seepog"e-pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT, f I SEPTIC TANK f Size...........................t.................... Liquid Depth ......__................. Capacity ---------------- -.- Type --- ................ Material...................... No. Compartments ........I............. Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE No. of lines ....................J_ Length of each line..-----.---.......-.-....... Total Le I ngth ............................ V Box ............ Tvpe-.Filter Material ....................Depth Filter Material ............................................ Distance to nearest.- Well .......................... Foundation ....... ..... . Property Line ....................... SEEPAGE PIT Depth ------- ----------- Dia'meterxz�:.� ..........Nur�ber ........... .......... Rock Filled Yes [3 No C3 3 Water Table Depth ........1............. .....................--...Rock Size .— ......................... Distance to nearest: Well ........ ...............................Foundation ................. Prop. Line...................... ......... ...... RREPAIR/ADDITION �Date . ADDITION(Prev. Sanitation Permit# ............. --------------- ------------ Septic Tank (Specify Requirements) __�XIS,77�1)VG...... ....... ................................ 0.............*...... ------- ........... WE....... Disposal Field (Specify Requirements) 6 /4&,qa."4 ------------------------------------------------------ 001-4- ---- - -----------T-f-I----------< ......................•.....--- ------------------ ------------- -------------------- ---------------------' .....................I.................. (Draw existing and !equired additioh on reverse side) I hereby certify that I have prepared this application and,that the work will be done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health.District. Nome owner or 11con. sed agents signature certifies the following: "I certify that in the performance of the work fpr'which this.permit Is issued, I shall not employ any person In such manner as to be 0 su". 1 to Workm ' Compensation laws of California." Signed 71 - -----:: C owrrai� By -------------- ----------------------------------------------- title (If other than owner) FOR .13 PARTMENT USE ONLY APPLICATION ACCEPTED BY ----- . ....... ---- -----------------------------I——--------- ......:,---.,DATE /V /;7 BUILDING PERMIT ISSUED-- ------ ------------- --------------- ------------------- ................... ...DATE ................ ......... ADDITIONAL COMMENTS . • 1 4 4 .......... .............................•.-..--_..... ---------------------------- --- ------------------ ------------------ ------------ -------- ........ ......................... ---------------- ...... .......................................................----------- -------------- -------------------------------------------------------------------- ................. -------- ---- I - ------- ----- --------------- Final Inspection by:------------------- ---- - ---41..................................................... -------------------- - - ----------------- ............ Date .................................. ------------ • EH 13 2h 1-68 Rev- 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 7 *1h 3M