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{f'FJ_R OFFICE USE APPLICATION FOR SANITATION PERMIT 77_ � Permit No. .. .... ............................. . (Complete In Triplicated ' Date lssuad ................. V... .......................... This Permit Expires I Year From Date issued Application is hereby made to the Son Joaquin Local Health District for..a permit to construct and Install the work herein s with County Ordinance No. 544 and existing Rules and Regulatlonsr described. This application Is made in compliance w C y 9 �., JOB ADDRESS/LOCATION ............................. CENSUS TRACT ............... Owner's Norrie . . . t om... _ ......................I............ _ ..:.::Phone ...... Address ��. .�/ .,:" '".a r�..� ._...City ..... ..:.:............................... Canticd4r's Name .< � :...:.... .......F .._. ..License # ��...Jk ------• Phone _ : _ Installation will serve~ a dente® artment HouseQ Commercial oTroller Court O E Motel-�Other.......,_-•-------------------------------- Number ofAiving units:............ Number of bedrooms ... __..Garbarge Grinder ....----.... Lot Size •................ .......................... Water Suppiy: Public Systam and erne ..........................................private r � { � .. p � yam_-� •---...�......----�---.._�_. . �._......O.. .. y � a r Character of soil to a de tft of 3 fest:: Sand Silt Clay [] Peat San Loam Clay Loam Hardpan❑ Adobe Q Fill Material .........._.If yes,type............... ........ d j till (Plot pian showing site bf 16t- location of system In rotation to wells, buildings, etc. moat be placed on reverse side.) j NEW iNSTALLATIONs (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC l f TANK( Slse........_.•--•--------------............ __. Liquid Depth ............ .... No. Compartments ... .. ...........Capacity 4. pe ._Material............... Distance to nearest: We � .--- ..........Foundation /a .-_...... Prop. Lino gLength .-.....f--•-•-••---- LEACHING LINE, { D No. of lines .. ..._. Len th of each Ilne.. Q.1. ......•.... Total ��................ 'p' Box - -- Type Titter Material ._ ....-Depth Filter Material ......................... Distance to nearest: Well ........................ Foundation ....---...... ........... Property Una 6 Diameter Number Rock Filled 'Yes ❑: No Q�! ' SEEPAGE PIT `,{ t Depth ---•:.,........ ................. Water Table Depth ...-•--------•..................................Rock Size ................................. l VN: Distance to nearest: Wel! ... ................Foundation . Prop. tine . ' a. }: REPAIR/ADDITION tPrev. Sanitation Permit# •--•........................................ Date ,.................................I ............... ................................................................................. . ..............._.............. Septic Tank ~Specify Requirements! . ....;t ' DisposalField tSpeclfy Requirements) ................................................... ............................................................ ..................... ..................................................... ----------.....----..............-----._......_.........._........----................_.......................... ............ ,. r, ........•-----....... _................_..........................__..:.. ..................•--s•-------------...............................................................,_......._........ Drow existingand required addition on reverse side) I hereby certify that I have prepared this application and,.that the work;will be.done In accordance with Satz Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Horne owner or Ileen- sed agents signature certifies the following: "I certify that In the performance ofthe-w&Vfor which this peir"It-ls issued. I shall not employ any person In such manner as to-become subject two Workmiii's Compensatlon_laws_,of-California:'__ -- Signed ............ ................ .................... Owner ? {If other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. � .a. ZK�.�........................... DATE BUILDING PERMIT ISSUED .DATE ADDITIONAL COMMENTS .................... { ....................................................................•-----_.. ..................................................................................................... .............. ...... Final Inspection by. '� ..............................Date .. -- �._.` ---•-• . EH 13 24 1-68 Rev. lSAN J0AQUIN LOCAL HEALTH DISTRICT S/7� 3M 4