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FOR OFFICE USE: le��l ....... APPLICATION FOR SANITATION PERMIT Permit No. .......... .................................. (Complete In Triplicate) ............... ........ ........I.......I.........A This Permit Expires I Year From Date Issued Date Issued .................... Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work heroin described. This application is made in coj!�nce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION Ang-r&, L -9 ....................................CENSUS TRACT .......................... L -L--oe- Owner*s Name ................. . t g ............. ...........Phone Address .......—............... �10 ...... CI .......... ----------- ....... City Contractor's Name ............. AM G..: --- ...... ____.License # ......................... Phone ............ Installation will serve- Residence 0 Apartment House 0 Commercial oTrallor Court 0 Motel []Other........................ Number of living units:_1... Number of bedrooms --_Garbage Grinder -/....... Lot Size 3 ...................... .. ... Water Supply. Public System and name ......................................... ............................... ....... ........................PrIvate-W Character of sail toa depth of 3 feet: Sand Silto Cloy peatE] Sandy Loom.g( Clay Loam o Hardpan Adobeo FillAkaterial ............ If yes,type............... ............ Mot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION- jNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f ) SEPTIC TANK f I . Size................................................ Liquid Depth ...........................00 Capacity ----------•-•.....•. Type -------- ........... Material....--- -------------- No. Compartments -------- .............010 Distance to nearest: Well .......Foundation ............... ...... Prop. Line ............--...... 0 LEACHING LINE No. of Lines .............. Length of each line......... . Total Length .... ........................Xk V Box . -AV Type Filter Material ....................Depth Filter Material -.........I............................... . Distance to nearest. Well ........................ Foundation ........................ Property Line .............. ......... (6 SEEPAGE PIT Depth .................... Diameter -........ ...... Number -.......................... Rock Filled Yes ❑ No C] 0 Water Table Depth ... ..................... ----------------------Rock Size .............................. Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# 1910........................ .... Date ..VziA!.6.q............I Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) .......i4- ------- ...............I--------------- ------------------------------------------------ .......................................I............................-................. ............ ........... -------•----------------------------------- --------------- -----------•-------•-._..--•---. ----.. ..... ---------- ...........I............-...................... ........ IDraw 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 H*aI&DI*tdct. Hone* 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 *hall not employ any person In such manner as to become spNect to Workman's Compe sation laws of California." Signed —---f._- ----- ----------- Title-----------Owne By -------------------------- -------------------- -------------- -------------- ---------- - ... ... ^e.. ...... ................. ...... (if other than owner) T FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----�-- ---6 BUILDING PERMIT ISSUED ------------ - ------------------------------------ ------------- DATE 1-37-V--------------------- .................... T'.�............... ... ---DATE ............................. ADDITIONAL COMMENTS --------- ------------- ----------- ------------- --------------------- ----------------------------*-------------------------- ----------------------------------------------------------------------------------------- ----------------------------------------I------------ ............................................. ------------- ------------- ---------------------I......... ------------------------- ---------------------------------- ..............-1-... ....................................... --------------------------------------------- - FinalInspection b-y-. ---------V- ------------------------------------------------------------------------------------- -------7-f--------------------- ---------6V.4.4�e. - - ----------------*------------------- ........................... .Dote /7- ............ EH 13 2h 1-68 Rev. 5m �&AJOAQUIN LOCAL HEALTH DISTRICT 8/711 3M