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0R OFFICE 0Sf: p APPLICATION FOR SANITATION PERMIT Permit No d '. ... (comp v.r .. _x...: d _ _ ....................... �_ late in T ripllicat8y _ .•__ b _w. ........ . _ -.,..�. .w .._.._ ,., .,. Date Issue ._.. ...._... This Permit Expires ] Year From Date lssu�ed = l the work r Application is hereby made to theSon Joaquin Local c l Health alth DiCounty tri t forncs No 549 and exir it to const i g Rules tand Regulations,fein described. This application is P .f L .7..... .... _p .. ...................... . ..............CENSUS TRACTA .................. .... ATIONJOB ADDRESS/LO ...-. Phone -. .... ... Owner's Name .---.... 6 _ . Bpd -... �. . ....l /.�.7.. � ��. City .. .. ....._.......-.......................yy.. Address . - ..__ ...._.• se _ - Phon .........-.7..._.... . . _._ / _•_ .. w ....._.Elco- #� .: '�. e ` Contractor's Name _...__..__..r.. ....:.� ............. , installation will serve: Residence�Apa ment House�] Commercial❑Traitor Court ] cMatel ❑Clt er ................:........ .................. - f t 3 Garbage Grinder ............ Lot Size 1/a ..... Number of bedrooms 9 Number of living units:..._. : ---=--••--•- ...........Private Water Supply: Public System and name -----------------------------------------............ .......................... Character of soil to a depth of 3 feet: Sand d Silt❑ Clay ❑ Peat❑ Sandy Loam{ Clay Loam Hardpan❑ Adobe Q Fill Material ............ If yes,type ............... ............ * : `buildings; etc. must be ptaced on reverse side.( (Plot plan, showing size of 'lot, location of..sysiem .in relatli rt"tii wells, R- or seepage pit permitted if public sewer is available within 200 feet,) NEW INSTALLATION: (No sop#ic tank SEPTIC TANK ...._.... Liquid Depth ................. ......... PACKAGE TREATMENT [ ] � l,..-.._. Size---•----•............................._. q P .. — a _..._.. Material No. ..........17 •- 4 Capacity --------- • ...... ._. Fdund aon ..... Pro Line Distance.to nearest: Well :-------�:....................•- I F •. S _� Total Length 'LEACHING LINE [ ] No. of Lines ----------- ----------- Length of each iir�e.. ., ...-------..... g 'D"®ox ............ Type filter Material ---.---Depth a M Filter Material .. ...... ........................ ......... ' Property Line .......... Foundation ..... ...... ........... p ty t �Diytance-10 nearest: Well ...------_•�• R Diameter Number ........:........•--.:..:_.. Rock Filled Yes Depth p. No SEEPAGE PIT �[ } p . ..._.............. _._..----..._... • Water Table Depth -- --...Rock Size ................................ ..Foundation ... Distance to nearest: Well --------------------------- :.. Prop. Line ---• ................. REPAIR/ADDITION(Prev. Sanitation Permit# __....,-.-----• -----------------------••-----------7_•--- Date .......... .....•--- -) 4 _ ....................... ..........___.........._.......... ............................... Septic Tank (Specify Requirements): --• ...... ........................... 1, Disposal Field (Specify Requirementst ----- ...:.. ........... .. ....•-- . I --•--•-•----•-------•--•-----.._._... I a f (Draw existing and required addition on reverse side) ! thereby certify that 1 have.prepared this.application and that the work will be done in accordance with San l�a�en- County Ordinances, State Laws, and Rules and Regulations of the San .loaquin Local Health.District. Home owner or licen- sed agents signature certifies the faliawln'. . , ploy any parson in such manner "I certify that in the performance of the work for"which this permit is issued, I• shalt. not en► as to become subject toWorkman's Compensation laws of California." _ �a Signed ------_... ......... ----------•----------- Owner4n *y By % .._.r --------------. Title (If other n owner) DEP TMENT USE ONLY APPLICATION ACCEPTED BY .✓ DATE :h_.:2• _:f- . .-0.: - - _ I.---DATE ........................ BUILDING PERMIT ..ISSUED ".".....-.1-................... ----•--- ...._,_ ..._..----•-------._. - ` -- - -----------------•--......::..........-........._.... ADDITIONAL COMMENTS ....---------- . ------------------ ------ ----•-- -- - --- ---------- ---- -------- ---------- -------D .... r:r final Inspection b ate .. ..,. I' EH 13 24 1-68 yM SAN JOAQUIN -LOCAL HEALTH DISTRICT � � 7h � a