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FOR OFFICE USE; r. SANITATION APPLICATI.O�' PERM permit No,,.7 3 ................................................ ............. -511com,plotollnTriplicaft) ..........1.:........................I................- Date Issued . This Per ,Year From Onto Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application isTa)d �' Wmpllance with County Ordinance No. 549 and existing Rules and Regulations: a n ............CENSUS TRACT ..•--••-......*........_._ . .................I........ ........... JOB ADDRESS/LOCATION ...... ..... ......... Owner's Name ... FPeem .......... ............ ....................Phone ..... .... ......... ---------- ...........••-•--• ............... ............... Address ---21.21.............mox........ .........—.. City .......__...... .. ... .. A ........ .. ... .. A ......... -------- ----- - -••._,..---------------------------- 61 . .... ... .........License # .... Phone Contractor's Name ......... --------- ------------------------- . ........... Installation will serve: Residence a Apartment'House 0 Commercial oTraller Court 0 Motel0 Other ............... ....................I------- Number of living units:_...!..... . Number of bedrooms ....S...__Garbage Grinder ..................Lot Size .......r Water Supply: Public System and name ........................ ........-.-.............................. ...............Private N1 Character of soil to a depth of 3 feet: Sand 0 Silt 0 Cie'y 0�, peat 0 Sandy Loom 0 Clay Loom 0 Adobe Fill Material --:�?Af yogi-typili.......-.... ........ Hardpan[3. (Plot plan, showing size of lot, location of system in relation' to-welli, buildings, etc. must be placed on reverse side NEW INSTALLATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ,1A,- PACKAGE TREATMENT SEPTIC TANK I I size...1 .......... Liquid Depth ................. .. 2- Capacity -JZPo---- Type No. Compartments ...................... Distance to nearest: Well� _....9....0 ................••_Foundation -Jd........ _ Prop. Line ------------ o J LEACHING LINE No. iof Lines ..}:'3'---_......._ Length. 410 each line........q.................... Total Length _•-------------..---••-- N I'd 1I It I 'D, Box Type Filter' M te lal . ....Depth Filter Material .................................. J01 bo " ......... .............. Distance to nearest, Well ............. Foundation ........................ Property Line SEEPAGE PIT Depth -------------------- Diameter .......... Number ................... ........ Rock filled Yes 0 No (3 Water Table Depth .......................... ----------- ..................... ...............Rock Size ...... Distance to nearest. Well -,-__•..............1..................Foundation ..... .............. Prop. Line ...................... Date .................... REPAIR/ADDITIONIPrev. Sanitation Permit# -•-•--------------------r:_--__..-.-..._. Septic Tank (Specify Requirements) ........................... .......... .. ........................................................ .......................---------....... Disposal Field (Specify Requirements) ................................1[------------ 1 ...................................-------------- ....... ............. ------------------------------------------------------------1------------ ---------------------- ................. ...................................... ...... ......... .............. ------------- ------------ -------- ------------------------------------------- ------. .......... (Draw existing and required addition-on-reverse side}; I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin the Son Jac eaI&DIstrict. Home owner or 11con- County Ordinances". State Laws, and Rules and Regulations a, ':f Joaquin Local H sod agents signature certifies the following: permit "I certify that In the performance of the work for'which this Is issued, I %hall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------ ------------------------...... ....... Owner ---------------------- ...... litle ----- ------------ ------------------------ ---------------------- By ----------- ........1------------------- - (if other than owner) FORIAODEVARTMEW USE ONLY APPLICATION ACCEPTED BY ----- ...... ..... . ........... .......I --- -------------- ............I.................. DATE ...7... BUILDINGPERMIT ISSUED ---------------------- ----------------- ............ :.............--• --------DATE .------------------1.1-1................. ADDfTIONALCOMMENTS --------- -----------------------------•--••------------- -------------------- -- -------------------------------------- -----I........................... ------------------- ...... ---------------------------------------------------------------I.......... --------------- ;------------------------------------------------------------------------------------------ ......I------------------------- ............................. ............... ...... ------------------ ................... ...................... ------------------------- --- --- --- -- --- ------------------------------------- .............. V ....... te -------------- Final Inspection by- -------- ------ ------ -W. ............... EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71; 3M