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FOR OFFICE USE: 22 rr�� tom . APPLICATION FOR SANITATION PERMIT �'f.J......................t.`" Permit No. ...737�r7' 1 y- (Complete in Triplicate) ......................... . . Date Issued .7Jy..... This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Healthi District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: '1 JOB ADDRESS%LbCATION _._.....•�� G.. "!:'•......_.....CENSUS TRACT :......................... �-- Phone . .�' Owner's Name .------- Address _ � i i. . ./F��-+!-..... City . _ R ..... -0- -.r�.icense #�, .`�`/� ��' Phone �� Contractor's Nome ..... .. t- -<�P (-i--f�= ~ Installation will serve: - portment HouseE Commercial E]Trailer `*' - Motel Other ..._- ... -- 7 ------••.. Number of living units:-..-.- Number of bedrooms -- ....--Garbage Grinder .p"" Lot Size ..._r- - c� •-----•••••--- Water Supply: Public System and name ._...-. .A<c- ?�' >--•----.... � L........ ....:....................... ...Private'' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat El Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 011 ---O PACKAGE TREATMENT t ] SEPTIC TANK Size-- - � `��--/ .. Liquid Depth .. --..._..•.....--•• r Capacity/, dna."4TYPe - �+✓':G�- aterial..1�.��C�o. Compartments, ---- •...... J Distance to nearest: Wel[ ---------------------Foundation .:.� _...........Prop. Line :__.�Y......__......N LEACHING LIN): No. of Lines - ..: . ._ Length of each line .... G�.,f Total Length ... .C,...�•..-== 'D' Box .-76r". . Type Filter Material _- .-._Depth (filter Material -:._..... /0 �.�.....------ . ' ' I-, l Distance to nearest: Well __ _.G ......__-.. Foundation /a....-..-- Property.Line ,------ --•--••-•• J SEEPAGE PIT 5� Depth �: ¢-- Diameter .:�` Number ........ ............... Rock Filled Yes No C3Water Table Depth _ -------------•-Rock Size ..._.. •------ Distance to nearest: Well ........ ............Foundation ----- G.. .. Prop. Line .__.. ...._.... REPAIR/ADDITION(Prev. Sanitation Permit# ..--•--. ............ --------------------- Date ------------------------------.----) Septic Tank (Specify Requirements) ---------------------------------------•- -•----._-._..._..............----......--_......_..._..._.. Disposal Field (Specify Requirements) .--------•-------------------- ---------------- ---------------------• - .......,................................................ - ------ ---- -------- •................ ....... .---.....---...._....................I------- --................ ..... . ............ .... ... .......... ......----- --....... ....... . -: ------- - -- ....... ..---.. ........_. -_------------- (Draw existing and required addition on reverse sidel 1 I hereby certify that I have prepared this application and that the work will be don* in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the-San Joaquin Local Health District. Nome owner or iicen- 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 ( BY �.._.... �4 ..r. 42 !�_.....(-Tpi. ....... --• Title -. �.... �.. .............._ . (If other than owner) FO PARTMENT USE NLY ( APPLICATION ACCEPTED 8 DATE ... BUILDING PERMIT ISSUED .... .. .._.>> y7 DATE ............ ............... ADDITIONAL COMMENTS ...:. .: `fi- .. ..... .... ....... �� /p -s _---• - --------- ----- ................................................... --------. •------- - - ----.......- a --- ...---- --- ------=------- . ...... __.... .. ----- Final Inspection byc ... :. .. .- Date ...._ AN J AQUIN LOCAL HEALTH DISTRICT .. _ .._ 7/72 3 M