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OR OFFICE USE: y APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. ..7................ -----.._._.._._...................I.....-- - � ...............•..........I........................... This Permit Expires ] Year From Date Issued Date lasued .�: . t 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRESS/LOCATI N ._. ��QT_-�% / �...........................CENSUS TRACT .......................... i Owner's Name ..--- -..� .. -441-- Phone i Address ...--S4.!!V.l..O�..............------.......•--•----..._...._.....--.--•L•--------------.... City ... . _. . . . . . .._._........._................................ '.._.._ . Contractor's Name pJ._//� I ff"_G... ..............License # .3;.7.,1R7..49.. Phone Installation will serve: Residence A Apartment House Commercial❑Trailer Court ❑ Motel ❑Other ............................................ Number of living units:__..._ Number of bedrooms .44�....Garbage Grinder .. ��. Lot Size ...41: ............ Water Supply: Public System and name .........Privat Character of soil to a depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam i❑ Clay Loam ❑ Hardpan Adobe❑ Fill Mcsteriol ............ If yes,type ............... ............. f (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 204 feet,) , PACKAGE TREATMENT l ] SEPTIC TANK l ] Size.........................I...................... Liquid Depth .......................... 9 Capacity _14,0d___- Type�!!t.C4.".r Material[! `s. a. �No. Compartments *2 ......... 9 Distance.to nearest: Well .5-.Q. .. • � _ Prop. Line ...._ .. --••-•-------------Foundation -- -.._ ........ LEACHING LINE [ ] No. of Lines ......�.------------- Length of each line..-.4r-a........... .__ Total Length ....I.X.0-ilf...... N V Box ------------ Type Filter Material ....................Depth Filter Material ............................................ ' Distance to nearest: Well __.,1_. E.__.__.._ Foundation _.. ............. Property Line ...ZAIK=.......t!\ SEEPAGE PIT [ t Depth ---tt'?-------- Diameter .'?XII.. Number ----------1r------ ...... Rock Filled YesAV No 0 Water Table Depth ..................••--•--..-------•--••-----....Rack Size .....�_.Z................... Distance to nearest Well bC1........................Foundation - .90. ...., prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. 3 Septic Tank (Specify Requirements) ......--...........-----------------------------------------...................---............ Disposal Field (Specify Requirements) ----------------_-- --------....--------•----•--•------•-----------•-------•-•-------•--:..---....._...... -----------------------------------------------------••---•1••--..• ----•-----• -------- ------------...................................................... --------------- ....................... . (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this applications and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Horne owner or licen. sed agents signature certifies the following: "I certify that in the performance of the work for'which this permit is Issued, t shall not employ any person in such nn nner as to become subject to Workman's Compensation laws of California." u Signed -- --------•-------------------------.....-.--•--- ----------------------------------------• Owner �'` BY ,.Cf^ -------------------------_ .---.....-• -------- Title _..._ '_ C�L.. t (if other than owner) FOR D1:PARTMENT USE ONLY APPLICATION ACCEPTED BY ........... - .' 41-11. _ --------. DATE - -..--. ..Z'31--?------------ BUILDING - .------BUILDING PERMIT ISSUED .........:..:........ ......•--------------------------•-•---- ---.. .. . .._..._DATE ......_..._................................ ` ADDITIONAL COMMENTS ---=--------------- ---------------........--................................................ ........................................................... ------------------------------------------ ------------....-..---------------...---•---••----..._.-----. -- -- ....._..............----•-- ........ --------•----•...............�, _:......... Final Inspection by- ------------- � ------------• - ............................. ----_-----_-----------.-Date _....1�._-rel'.7�.---...__...__. EH 13 24 1-68 Rev. Sm SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M