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rE�;K UFFICE USE: -- -------------------- APPLICATION FOR SANITATION PERMIT ...... ............................. (Complete in Triplicate) Permit No./-76..n Y _w ....... ............ This Permit Expires I Year From Date Issued Date Issued Application Is hereby made to the Son Jbaquin Local Health District for a described. This application Is made in compliance with County Ordinance Nom549 and existi g Rules#alnd Rg e ulotion sre►n .I JOB ADDRESS/LOCATION .eQ]SM .......•�_D.................................. � Owner's Name ......... ..........-.......CENSUS TRACT ....... ------_-----..........•----••-•----....--•------....••-••....-._..-.....Phone -C/.W.:-7 �.L... Address,--Cj.......N.tl�l_ ' ` �{ ---. city... . ( Contractor's Name - .__. _ si------ -_---License # ......._---------...... Phone ................ Installation will serve: Residence Q Apartment House(] Commercial ❑Traller Court Motel El Other Numb er of living units:-------_-- Number of bedrooms --..!------Garbage Grinder ------------ Lot Size . _ Water Supply: public System and name ------------- ------------- -..._ - - ------•-----•------------>---------•--•---- ----------•- -...-------..Private�' 1 Character of soil to a depth of 3 feet: Sand Silt Cla � ❑ Y ❑ Peat❑ Sandy Loam fl Clay Laam� Hardpan 0 Adobe❑ Fill Material .......... If yes,type............... ..... ]Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) y NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT ( ] SEPTIC TANK[ Size------=----------------------- -- ------ ------- Liquid Depth ------•-. .. Capacity - -•-----....--- Ca p Y . 2-0-0-. Type ?_-CP-T'a_ Material.C,�_dj_s .- No. Compartments ._ .-........ _.. Distance to nearest: Well .-_ �`�.---------- -------Foundation -.- ------ Prop.Prop. Line -----------•.......... LEACHING LINE [ j No. of Lines __ ! ---�-•---••-- Length of a ch line------ --•---------- ------- Total Length 'D' Box ------------ Type Filter Material _-..-- -Depth filter Material ................ -- . �....... II Distance to nearest: Well .�,�p.C?-� .S.E.`EP._A�GE�PIT, [ Depth . Diameter � F�ndation .'.- ......... Property Llnel>..�............... - 1X0Number ------- ------ - �----...-__ Rock Filled Ye�,M No [] Water Table Depth �Cr�.vvyo vV-5 .,.-... Rock Size .... Distance to nearest: Well ..--------------- ----------......-------Foundation ----_._._...------.. Prop. Line :.. .......... PAIR ADDITION Wrev. Sanitation Permit# .............---- ._.__ .-------------------- Date _.--•-------- Septic Tank (Specify Requirements) ---.................... ... ............-.............. ........................ Disposal Field (Specify Requirements) ............. . t - ------------------------ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the workwiJoaquin ll be done in ac with San Joa County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or qui sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall nest employ any person in such.manner as to becom jest to W a mpensation laws of California." Signed .......... --•----------•-------- • ---- Owner J�, aY •-------•--------•-------•---------------- - -- -------------------- Title - ^ (If other than owner) ---- ---- -------- ----- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... ` BUILDING PERMIT ISSUED ------- ----------- - DATE .....:. ---------------- ---- - - ----- -------------.-DATE h� = AA DDiT10NAL COMMENTS ---------------------------- - - - ----------- -------- - ................................... -------------- ----------------------------------- -------------•. -•-• --- Final Inspection by: -.- .-- n r --..--.Date EH -.�^— 13 2L 1-68' Rev. SAN .]OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M