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FOR-OFFICE FFICE USE: APPLICATION FOR SANITATION PERMIT ................... .........:......................... Permit Na A.-ZZL iComplete In Triplicate) w- .........: ... ..... ... .:............... This Permit Expires] Year From Doti Issued Date Issued 4112-..:.7.�- 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 made In compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESS/LA—TION ................./144 fD.. ).....................CENSUS TRACT .......................... Owner's Name J.�.� .... .. .��...f�2�................ ...... ................................ .. ..Phone .................................... Address ..... :..... ....�. �? •_ >Qs.. , �/• .......City _ > ............................. ................. Contractor's Name �..... . .19 __ .......................................Licen tf�" �„(...�y/... Phone .............................. Installation will serves Residence Apartment House 0 Commercial[]Troller Court 0 Motel ❑Other. Number of living units:........ Number of bedroo s .___ ......Garbage Grinder .... Lot Size ............................................. Water Supply: Public System and name ....... ..............._._.. .........................................Private& Character of soil to a depth of 3 feet: Sand Silt❑ Clay ® Peat[} Sandy Loam 0 Clay Loam 0 � Hardpan 0 Adobe 0 fill Material .-A....If yes.type............ .. ............ !Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse aide. NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( } SEPTIC TANK Size* . --T� ,...:�(�Q............ Liquid Depth . . �.�........... Capacity Type Material. _'-C No. Compartments Distance to' nearest Welt ...............Foundati� ... .�........... . Prop. Line ... L...... ;.EACHING LINE No. of Lines ......... Long t at each Total Le gth c_4_f.).. ...............0 ` 'D' Box 114e5-- Type Filter Material . 1 :... :Depth Filter Material ..�. �.(................................ to c Di t, Wel Distance e to nearest, i .:.&�* .. Foundation 4A.1.............. Property line S�f............... SEEPAGE PIT Depth ................... Diameter . F Number ............................ Rock Filled Yes ❑ No Water Table Depth ......................................? � . .Rock Site .......................... ..... � Distance to nearest: Well ............................... ......Foundation ................ Prop. Line ...................... REPAIR/ADDITiON(Prey. Sanitation Permit# .................... :._..................... Date .................................. .... ....-.) ............................._ ............. .... ... .. .... {.................................... Septic Tank (Specify Requirements' .............. Disposal Field (Specify Requirements) ..............!..................................................................................... ..................-............. . ................................................................................................................................................................................................ . ...............................•-------------•-------------•---•---------•--• ---•••-- -_-___................. ............... ........... (Draw existing and required addition on reverse side) I ._ { 1 hereby certify that I have prepared this application 'and-that -the-work-will-bo--done-in.-accordance with Son Joaquin i County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hoene owner of licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I :holt not employ any person in such manner as to become subject to Workman's Compensation laws of California." )'gnec ........ ...................... ..... .................:.................:..........:... Owner ...............__ By ..... ............. ... Jitle . .. ..,. ................................. .... .. .. .. . ... . .. ( of r than owner) FOR DEPOTMENT USE ONLY APPLICATION ACCEPTED BY ... .. ... ........ ........ ...... ` DATE !-. BUILDING PERMIT ISSUED ....... : .. .... � ''' ....... . . DATE .. ADDITIONAL COMMENTS ....._ / ... r..---..... .:'� . 7....-G' --.�f4..... . ... . $... 1"... ........................ .. ................. .......... ............................I.......... ._ ..... .. .......... .I.........:. --- . ..... ... _. ..I.................. ..._ --.......... i Final Inspection b ....Date.. . - --7................... EN 13 2h 1-60 V. SAN JOAQUIN L AL HEALTH DISTRICT 8/74 3M