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APPLICATION FOR SANITATION P IT. ._.__._..._....---- ' .........:..... Momplete.In Triplicatel Permit No. ...._-• - _- •--•-. ............................_._.................... This Permit Expires.i Year From bate Issued Date Issued .. .. �� rApplication is hereby made to the San Joaquin Local Health District for a permit to construct and 4install *isworlcirain •iescribed. !his application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: • JOB ADDRESS/LO ION . .. _. ,......,CENSUS TRACT Owner's Name - 1. Phone ............... Address iT _��:. ... �.1•e- .'City .. n ... �.. �i. r J Contractor's Name ... _. f,�? ter_--..•' ... mac._ y ---- ........... ............... ...... .....Ltoense � ��.,..��........ Thane ............ Installation will serve: Residence- Apartment House❑ Commercial❑Trailer Court a Motel ❑Other--.............. . .. Number of living units .....I---• Number of bedrooms ...,,3_._Garbage Grinder ............ lot Site ............................................ Water Supply: Public System and name ..............---............................. .................................................Private [r' Character of soil to a depth of 3 feet: Sand❑ ilt❑ Clay ❑ Peat❑ Sandy Loam Q Clay 4oam ❑ Hardpan j�Adobe❑ Fill Material ............if yes,type ............... ............ (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 see ge pit permitted If public sewer to available within 200 feet,] PACKAGE TREATMENT j ] SEPTIC TAN tG Sixe lr. ',/l_ f" l ............... liquid. Depth . ._.... ........... Capacity IAS_..___.. Type Material. ,,. No. Compartments . 2 ..._ ..... Distance.to nearest: Well _.____._, - ......foundation Prop. Line.4L5 ......_.. LEACHING LINE No. of Lines -------- .___..,-- Length of each line...... ..__.. Total Length .f.% ly, ...l..... V .D. Box Depth .Filter Material .. .__. .___... Type filter Material ....._... ......... <� Distance to nearest: Wel! :....�®:� Foundation ......�.�.. ... Property line ..�...._. ? Z SEEPAGE PIT [ Depth ____-_•-•----- Diameter Number ......... ................. Rock Filled Yes �No ❑ Water 'Table Depth ............. '. , .....................Rock Size .--1........................... r Distance to nearest:Well ......... '.. ,. ....------..Foundation ...I.C.� Prop. ltne73.. ....... REPAIR/ADDITION]Frau. Sanitation Permit 9f•` .......................................... Date ---:---•--:-• .................... Septic Tank (Specify Requirements) Disposal Field (Specify Requirements] ---••----- ...........................-----............ .....................--_....................... --......-.......... .................>........._.-.............---............ ----•--------•-' #Draw existing and required addition on reverse side] I hereby certify that Il have prepaired this application and that the work will be done in accordance with San immuin County Ordinances, State taws, 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, I shall not employ any person in such manner as-to became subject to Workman's Compensation laws of California." Signed ------------- - .._. q. Owner By ........... •---'-'---'- .....• . Y,i ctf"; � c�,,a�-. _ Witte ``'�:`" "er s_... (if other than owner) '1 FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED By ------- -------------- ------------------------------ BUILDING PERMIT ISSUED ------'_-- ----- _.. ----------------------------------- - -------------------- -------DATE-...... .__.._.....__..__....--------- �DDITiONAL COMMI:.NTS ------------------- ---•-....---•-- ------------------- - .......... _ ---------- ----------------._._...._.......--- . -----•------------------------------------ .........,......----' --------- --- Final Inspection by- --------- -----'- Date -�. . ` Ell 13 2h 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M