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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 4�i Permit No.7.2-- -? 1. (Complete in Triplicate) .. .. ................... This Permit Expires t Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulotions: JOB ADDRfSS/LOCATION .. ." Q-C`.--. ...........................................CENSUS TRACT .......................... Owner's Name .. _....-fr." . '=-...................... ...........................................Phone .................................... r Address . ..��. �-.... ------------------•.--------------•.------•----.City Contractor's Name ---•`<. .. 47Apa�t •.........................License#�`��c L. '�.... Phone installation will serve: ResidenceHaw:efl Commercial oTrailer Court E MotelQ Other............................................ Number of living units:_..---.... Number of bedrooms .....Garbage Grinder ............ Lot Size ... `a�'X... .. ......... Water Supply: Public System and name ........................................................_-...................................................Private Q Character of soil to a depth of 3 feet: Sand E] Silt Q Clay Q Peat Q Sandy Loam ❑ Clay Loam Hardpan 0 Adobe 0 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,( i PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size.-..r'� `,e� Liquid Depth ..� .................. Capacity�. t!�.t _ Type _�.. .. Material--[ _...... No. Compartments ........ ,7..-j.. ents fa .. . Distance to nearest: Well _� ....Foundation ./ Prop. Line V� LEACHING LINE [ j No. of Lines ------Ai--------------- Lengt of each line....... 4'-4..._ .. Total Length ............. 'D' Box .....I.... Type Filter Materia) -..... ..Depth Filter Material ...�.�1 �—............................ Distance to nearest: Well ..... Foundation ........JI'T..... Property Line ........................ SEEPAGE PIT [ j Depth ...... Diameter .34...._... Number ........�Pg.............. Rock Filled Yes No 017 Water Table Depth ••••-•••-•..............................••--....Rack Size ......•••.............. Distance to nearest- Well ........................................Foundation .................... Prop. Line .......--- ...... REPAIRJADDITION(Prov. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) _..:_._... ...................................,........._.....-•••........ Disposal Field (Specify Requirements) -------•--------------•--•••-------....---•---...---..._........_.........._...----•---•-----...-----.........._..................... ------- .......................................---............................................................................................................--........................I....... ............................-................._............................................................................................ (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 Sc4 Joaquin Local HOW&Distdd. Heine 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 BY - -- VA-7_'. .Cz .. ---- .................. Title .......... ....... If Cher h n o er PARTMENT USE ONLY APPLICATION ACCEPTED BY . ... .... ......... . DATE .- '' ... . ... ------ ._... = --- ---- ........-••..._......... --------- .......----DATE - .............................. BUILDING PERMIT ISSUED ADDITIONAL COMMENTS _-- ---. ;._. . .. ...................................... ...._- ......................----- .. Final Inspection by: ---- {.. .... .. -- Ym. �7.7.............. Fri 13 24 1-68 llev. 1 �j SAN �? ECRL H H STRICT 8/74 3M