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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT �s /o --•- ......._:I- tComplete In Trlplicatel Permit d ....::.. -- .•... .............. This Permit Expires t Year From Date Issued Date Issued ........................ 3 F 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 mode-in compliance with County Ordinance No. 549 and existing Rules and Regulations: �(r11 � 30B ADDRESS/LOCATION -:.,�..._... .... r d .11� :N .............:5. ,..a:� � .:............CENSUS TRACT ................. Owner's Name .../f v Gt1e1nnM U/"'1................................................. Phone . f.-�. ` .... Address .... � ? Gr��N ...` ........................I City .51'F'n(�A.Te!A ... . ... Contractor's Name ..Q /i' /�._- ...... :. . ......................................License # . .. Phone Installation will serve , � Residence P1 Apartment House 0 Commercial QTraller Court (3 Motel 0 Other............................................ 1t?Z + 3 Number of .living units:-../ Number of bedrooms ...z......Garbage Grinder ............ Lot Size i Water Supply: Public System and name �. .:..:_.:...Private ............................... ........_........_ _._...... ........ ........ Character of soil to a depth of 3 feet: Sand n Silt 0 Clay 0 Peat❑ Sandy Loam.C1 Clay loam 2J. Hardpan fD Adobe 0 Fill Materlai ............ifes a............. ............ y ,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 240 feet,) PACKAGE TREATMENT SEPTIC TAMC Size._.. .......�........ :................ . Liquid. Depth ......................,..... Capacity 1,206. :-=Type Material e r�0No. Compartments .. '.. _J Capacity Distance.to nearest: Well :./P. ............::...::.Foundation .....1�.......... Prop. Line ..........p LEACHING LINE ) 7No. of L nes ..: f; length of each line..-.. ....:.... Total Length /' ......... r{ . D'"'Box .... Type Filter Material ....Depth :Filter Material ....:. Distance to nearest: Well /0D �:=.... Foundation _�f?................ Property Line .�4...............� . E l � ..... ..-...�............ Rock Filled Yes;( No Ip I o � A SEEPAGE PIT Depth ._::1P'i.!.._.... .. Diameter .�fr.'� Number �—' Water Table De th -:- p ..Rock Size ..Z. 'Distance to nearest: Well ..../ ................:.:Foundation 74.::...... Prop. Line :> ........ .�. REPAIR/ADDITION(Prev. Sanitation Permit t ...... Date ........ .. ...... .............................a. .....I...: ........ ::.:'. .. . . '.... . Septic Tank (Specify Requirements) .... ... .. ....................:... .i -Disposal Field (Specify ;Requirements) - -•-- --......_........... .......... ....•-- ..............-----------------...._.................................... ..................... .. _ ...... ...a.............................. .:. .... ....., ....�_. .. .. --�--_ _--•_• _•_ ...... ... ..... .......... ........................... �...._.. _......... .... ........... .... ......: .... .... (Draw existing and,4equ red addition on reverse side) I hereby certify that l hav®prepared this appliealion and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and-Regulations o`f the San Joaquin local Health;District.Home owner or licen- sed agents signature certifies.the#ollowing�F i "I certify that in the performance of th6 vwork for'which this permit is Issued, I shalt not employ any person in such manner as to become subject to Workman' Compensation laws of-California."., Signe ' -?-t^r. ----- -----.._------ Owner By ........ • Title :................ ..... ..... ----- (if other than owner) DE ARTMENT USE ONLY APPLICATION ACCEPTED 6 :. .�._ . ... .... ... .: :®Z..: DATE BUILDINGPERMIT ISSUED ... .................... ........•.• ----- ---------------_-------- ............ ..........DATE ................................. ADDITIONALC{OMMFNTS ._.._._.. •---: .....--- .................. ................ ........................................,.....................:.......:....:.........:..._ .. .. .......... .............................. ..................... .. ..........._.. .................................. ............ ............................. ............ ... Final Inspection by: .... ------ - - - ---- --- ------ ....>. ....------•--•----------- ... :... ......... .. :.._Date ..� ..../ ...................... EH 13 .2h 1-6f3 Rev. 5H SAN JOAQt1iN LOCAL,.kIEALTH DISTRICT 8/711 3M .