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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------------------------------------- (Complete in Triplicate) Permit No.. ............1�--------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued -- ----------------- ---------------------- -- :--- ---------- Application is hereby made to the San Joaquin Local Health District for a per"mit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- JOB ADDRESS/LOC TION "31 kxcT -------------- ----------- y---------------- Owner's Name _VVJJ_1_�a--- 42,0_y_'e_�;7-------------------------------------- ----------------- -----.-Phone -------------------_- -------------- I — Z --------------------------------------_------ city ----------------------------------------- Address --------gw*-----y ;i- - Contractor's Name -----4LV,-rz�....... --------------------- ----------License # ; _W 1 4r Phone BZ3!��&... Installation will serve.. Residence 1?�Apartment House,[] Commercial :oTrailer Court .F] Motel M Other -------------------------------------------- Oda Number of living units------------- Number of bedrooms A------Garbalge Grinder ------------ Lot Size ---4------------If----------------------- Water Supply: Public System and name ---------------------------------------------------------------------------------------- ---------------------Private Character of soil to a depth of 3 feet: Sand 0 Silt[:1 Clay 0 Peat E] Sandy Loam -[-] Clay-Loam.0 Hardpan E] Adobe,F-I Fill Material .----------- If yes,type ---------------------------- (PI'ot 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 feetA - -- ------ Liquid Depth ----- ------------ n PACKAGE TREATMENT SEPTIC TANK;[ Size----- .. .. e-7 Capacity ---- Type P12f_0415tatericil_Cor✓e_ e7 oNo. Compartments __9--------------- Distance to nearest. Well ------ ---------------------Foundation ----1-0-----------.Prop. Line ----(5--- ---------- LEACHING LINE No. of Lines -----i.2-------------- Length of each line------YO------------- Total Length/71�--- ------- ------------ 'D' Box ------------ Type Filter Material r J --Depth Filter Material ----- ------------------------------ Distance to nearest. Well -----4�---------- Foundation _Z-4-T)------------- Property Line ---------- SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 WaterTable Depth --------------------------------------- --------Rock Size ------------------------------- - )kv Distance to nearest; Well ____-----------------------------------Foundation -------------------- Prop. Line -_------------------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ----------------------------------------------------- Disposal Field (Specify Requirements) -------------------------------------------------------------------------- ------------------------------------------ ----------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- (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 County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- 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. __19 Title --------------- -------- ----------------------------------------------- ------ ----------------- BY. (if other t an owner) FOR,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------Z/�-07_4_�-- -------------------------------- DATE ------------- BUILDINGPERMIT ISSUED ------ -----------------------------------------------/-------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- ------- -------- /---- --------------------------------------------------7- -y--------�_J Final Inspection by: -------- ------------------------------------------Date -- ---—- ----- ------ 21 SAN J QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M