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FOR OFFICE USE:' - r APPLICATION FOR SANITATION PERMIT Permit No. 4_!7�n_4��_�_: (Complete in Triplicate) .................................................. 4 Date issued --___----- i This Permit Expires t Year From Date Issued t 1 -4 `(O - f0 Application is hereby made to the SanrJoaquin 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: Eric >4� JOB ADDRESS/LOCATION A--- � ----- #--,-�--S--�---�-�--_-i---aCENSUS i�T R4ACTf�-�-.�- ---------�------_- f Phone ------------ ------Owner's Name __A------Address --- = city - � 3 _ Phone ---ran--_163-1.Contractor'3 Name 4�---- J --------------License f Installation will serve: Residence [i]-Apartment House❑-Commercial:❑Trailer Court ❑ i Motel ❑Other -- ----------------------------------------- Number of living units:__________ Number of bedrooms -_-------Garbage Grinder AVO Lot Size -__ -------- Water Supply: Public System and name ------------------------------------------------------------------------------------------ -------Private [}�� Character of soil to a depth of 3 feet: Sand' ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay,.Loam ❑ ! p Hardpan ❑ Adobe ❑ Fill Material _f10-Q-__ if yes, type ______________`_______ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.j 11I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is a ailable within 200 feet,] PACKAGE TREATMENT ( ] SEPTIC TANK' Size__ _ _ 7 --------------- Liquid Depth ___7_ ___.__,_____ C acity __0 ��------ Type _ - -- I_--- Material+ _`2 Yj_<__ No. Compartments -- -------.•-•.-- 'stance to nearest: Well I___ _ _____________________'___Foundation __lv'------------- Prop. Line ----�________._..__� LEACHING LINE [ No. of Lines _____ _______________� Length f each line_-___� -}- Total Length/r-___ __.....__.___. 'D' Box WO---- Type FilteriMateria __,Depth Filter Material ------ _______________________________ 1 1 Distance to nearest: Well ---- Foundation - -------- Property Line _____ ----------- SEEPAGE PIT [ ] Depth -------------------- Diamete'r`-"�____'"'------ Number ------ ----------- _________ Rock Filled Yes ❑ No ID Water Table Depth ------------------------------------------------Rock Size -------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. line -----.---.-------------- REPAIR/ADDITION(Prev. Sanitation Permit# --------------- -?_-- --_ --`----=---•--- Date ;---------------------------------} I Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------------------------- ------ Disposal Field (Specify Requirements) --------- --:--` ------_-----•------------ ---------------------------------------------------- ---- ----=------------------------------------------------------------------------------------------------------------------------------------------- __ --------------- --------- ------------------------------------------------------------------------- _ ,_ (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 San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to becoorn sub-ect to Workman's CompensaYon laws of California." Signed__/5Z_ A-------.�.C-. � ��/ Owner r (If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------------------------- DATE .... ---------------- BUILDING PERMIT ISSUED ---------------- ---- --------------DATE ----------------------------------------- !- ADDITIONAL ----------------- -- ADDITIONAL COMMENTS --------/-7------------------------------------------------------- -------------- ----------------------------------- -------- - ----------------------- _ � - ------------------ -- ---- ---------------------------------------Date Final Inspe - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT ' E. H. 9 1-'68 Rev. 5M,