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FOR OFFICE USE: FOR SANITATION PERMIT --------- (Complete in Triplicate) Permit No. -.-------- ---------- -------------------------------------------- "�Dcite Issued Date Issued e:�-If4W --------------------------------------------------------- This-Permit-Expires,11 Year-From Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance w:ik County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATIO CENSUS - -- ..... , - .0 Owner's Name ------- ..........I --- --- --- Phone - ----------------- ----------------- ---------- ._ ]-'_7_( ...---------- -- Address -------------------------------:2- ---- --- --- ----------------- ----------------------- City ---------------------------------------- Contractor's Name -------- --------- ---- Phone 9466, --------License --- ----- Installation wilt'serve:----R6-sidCn-c-�-P(-Apartrnent-House--El-Commercial :E]Ti6iler Court-0 Motel F-I Other ----------------------------------- Number of living units:.____.____ Number of bedrooms ____.-____Garb!qe Grinder r'�-Lot Size! �-------------------- � , WaterWater ------------------------ ----- Supply: Public System and name -------- ----- ------------ ---- ----- --- �4 t --------Private El L Silt E] Clay E] Peat 0 a rn�.0 Cloy Loom 0 Character of soil to a depth of 3 feet. Sand C1 Sandy Loan; Hardpan E] i Adobe Fill Material------------- If yes,type -------------------------- l (Plot plan, showing size of lot, location of systemin relation-,.to wells,�b:Liilclings,' etcmust be placed on reverse side.) A r- 1�1 11 f-I NEW INSTALLATION: No septic tank or,see�cige pit permitted if public sewer davail'able W�Ithin 200 feet,] 4$- f lo, I SEPTIC TANK ]-1 1 Size--- ---------------- ----------- ---------.-- Liquid Depth ----:--_:--- 0' TREATMENT f r 1 -11 01 Capacity -------------------- Type --------------- --- Materia-I i---------------------- No. Compartments -'/------------------- - Wei 1 7 - Distance to nearest. -------------------- --------C-'Founclation -------------- ------ Prop. Line ---------------------- LEACHING LINE No. of Lines ________.......rt,_- __..,Length of.,�each line____________________________ Total Length .---___.____._______________- -'D' ----------`-,,Type Filter Material -------------------_De th Filter Material -------------------------------------------- ' I-------------- Distance to nearest::,�Well Well----------------------- Foundation -------- Property Line, ------------------------- SEEPAGE PIT Depth ------------�' 'Diameter ---------------- Number _.____._.____I-_-----___---- Rock Filled Yes EJ No C Water Table Depth -- -----------------------------------------Rock Size ---- --------------------------- F i Distance to nearest: Well ----------------- --------------------Foundatio.—--------------------- Prop. Line ---------- REPAIRfi4/.6,TION(Piev. Sanitation Permit# ------------------------------------------- Date _______________.______________.___l S�eptic Tank (Specify Requirements) -------------------- -------------------------------------------------------------------------------------------- ---------------------------- disposal Field (Specify Requirements) -- -------- ----------- - -----------Ar-------------------------------------------- I-, 7,.IV --- ------ - -- -- ----------------------------- ------------------------ ----------------------------------------------------------------------- ---------7-,V -------------------- --- --- =--- ---------------- - - -- -- - -------- rl - ------------ --------------------------------------- ------------------------------ fDrow.existing and.requ-ired-additi6n on rever"se side) I hereby certify that 1 have prepared, this application and that the work will be done in accordance with Son Joaquin ; County Ordinances, State.LavKs, d Mules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the perFormar4e,oF the work for which this permit is issued, I shall not employ any person in such manner, as to become subject4to Workman!s Compensation laws of California." Signed -------- ------------------- Owner By - --------------------------- Title -------- -------- ------ ------- -------------------------------- ------- ot ot t an owner) FO --09PARTM&"T'�USE- PNLY 'T ------------- ---------------- APPLICATION ACCEPTED BY -- -----e4e--- DATE ------- BUILDING PERMIT ISSUED --------------------------- --------------------------�---,I--ZATE.;L-,------------ ---------- -------------------------------------------------------------------------------------------------------------------- -------------- ------------- ----------- ADDITIONAL COMMENTS f- I ----------e ------------------- ---- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- - - Final ------- ------------------------------ --- ----------------------------------------------------------------------------- ------------------------------------- ------- ----------------- --------- --------------------------------------- ----------r Inspection by-- --------/-------" -------------------------------------------------Date -- SAN J&AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M