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FOR OFFICE USE: ,APPLICATION FOR SANITATION PERMIT _7 .................... .................. Permit No. ;Complete In Triplicate) ............................ .............. . 7) Date Issued ... ..................................I............ This Permit Expires I Year From Date Issued Application is hereby made to the Son Joaquin Local Health District fora r 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: JOB ADDRESS/LOCATION ..V %?/ r .45 pt./ /4m -1 .;VA/ -fl- -- --- ----- ------�,04 . ................................. ......................CENSUS TRACT .......................... ,Owner's N=e_Z1V/a0W01 _..., Pr, I� VAG ................................ ......................................Phone Address .9"1......2 W,9 ------------_------------_ city ... ................ ...... Contractor's Name _.&AVre#VJ0_d....... ........................ ......... ................License # ...r...................... Phone ........... ....... Installation will serve: Residence(0 Apartment House 0 Commercial)]Trailer Court 0 Motel 0 Other ............................ Number of living units:............ Number of bedr Oms,.a------Garbage Grinder Lot Size Water Supply: Public System and name; ..Private .................................................................................. 0 Choracter of soil to a depth of 3 feet. Sand Silt Clay 0 Peat 0 Sandy Loom 0 Clay Loom 0 Hardpan 0 Adobe% Fill Material Al. .. If yes,type ............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse We.) NEW INSTALLATION- (No septic tank, or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK N ......... Liquid Depth ...YAM......... %P -17 CapacityZIA Type 44r material.ZW.: .... No. Compartments ;1 Distance to nearest-. Well _.__--A4 .................Foundation _/A............. Prop. Line ...................... LEACHING LINE [e j- No. of Lines __ Z& -JACe F........ ------ Length of each fine . ..... .. Total Length . ID, Box ...... Type Filter Material, .1f ....Depth Filter Material /40 ..........�-. ............ Vlb Distance to n:yrst: Well A&I......... Foundation ------ Property Line ........................ SEEPAGE PIT Depth' ------- Diameter %A0....... Number .........2---- --- Rock Filled Yesear No 0 Gr 10/ 11 Water Table Depth .... ..................Rock Size J'Am...........I........ Distance to newest: Well ...... ............ ........Founclotion ....... Prop. Line ............ 9 EPAIR/ADDITIONIPrev. Sanitation Permit# .)yWr4/9P; ................. Dote Septic Tank {Specify Requirements} .....................*....... ------------------- Disposal Field (Specify Requirer ...4MiAAJ/_%..... A&V.. ... -- -- --- ----;--- ---------------------------------*---------------------------- 40' .................................................... ----------------------------------------------------I........--.--•-.--.•-----...•. •••--•-•-•-••••••.--•••-•..._........................•...... JDr6w 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 C6unty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HeaI&DIstrld. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of th(,i work for which this permit Is issued, I.sholl not employ any person In such manner as to beconieslu-biect to Workman's Compensation laws of California," Signed -----------------------------------------------------................... ....... ................. Owner By ----------------------------------------------------- --------------------------------------- Title ......................................................................... (if other than owner) FOR DEPARTMENT USE ONLY ��O APPLICATION ACCEPTED BY ......................... DATE ... 7-_--___--7-..__ BUILDING PERMIT ISSUED -----I ........................7-1 -.--..-._----------DATE --------------------------------------- ADDITIONAL COMMENTS -------------- --------------------------------?............----1-------------------------------------- -----------I............... --------------- --------------- ..................I---------------------------------------------------...... ...................... ------------------------- ----- ---------------- _f , --------------------------------- -- - ---- ----- -- 17-1-1------------- ... .................................. ...... .... ......... ------Date Final Inspection by: --------- �2. jW 1-6 8 1 cN EH 13 24 5M SAN J QUIN LOCAL HEALTH DISTRICT 8/74 3M