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FOR OFFICE USE: „j0 APPLICATION FOR SANITATION PERMIT ' Permit No. ................. - (Complete In Triplicate) ............... I ............................................. ........... This Permit Expires I Year From Dohs Issued Date Issued ...... Application is hereby mode-to'the Son Joaquin Local Health District for a permit.to construct and Install the work herein described. This application Is made In complia" with County Ordinance No. 549 and existing Rules and Regulations! JOB ADDRE SS/LO ...................................CENSUS TRACT ................... ........ Owner's Name . .. ................ .......................... ..............Phone,................................... Address ....... .....�.4 city ...a-p—r............................................................. ...................__...... .............License # Phone-eli6j— Contractor's Name Installation will serve; Resiclencelp-A-pZrtment House 0 Commercial oTroiler Court 0 Motel 0 Other..................................... Number of living units...... .... Number of bedrooms Garbage Grinder ./f/,P Lot Size ZWZW-15�....... Water Supply: Public System and name ....................................................i�e-—-------------- .................................Private Character of soil to a depth of 3 feet: Sand Q Silt[I Clay �: Pe'a't[3 Sandy Loom 0 Clay Loam [3 Hardpan Adobe I'll I Mate I riaf .�.... If yes,type ........................... (Plot plan-; showing size of lot, location of system In relation to wells, buildings, etc. must be placecionte � Verse side.) NEW INSTALLATION: ' (No so (ptic tank or seepage pit permitted)fpvblic sewer is available within 200 feet.) PACKAGE TREATMENT SEPTIC TANK f Size....................... ;=-Liquid Depth ........................... Capacity)...I................ Type .........t......:.. Mbterial...................... No. Compartments .................... . X Distance to, n8areit! Well .............. ..... ---- ....Foundation ............... ..... Prop. Line ..................... LEACHING LINE No. of Lines .:-..`t................ Length of each lime............................. Total Length ........................... V Box ............ Type Filter Material ... ........Dip—tif',After Material ........................................ Distance to nearest: Well .............. Foundation --.�............... Property Line ........................ SEEPAGE PIT Depth ..................... .Diameter ............... Number ...... .................. Rock Filled I Yes [3 No 0 Water Table Depth ....................... :t....................Rock ......................... Distance to nearest: Well ............. ......................'-.'Foundation. � ........*........... Prop. Line .................. REPAIR/ADDITION(Prev. Sanitation Permit# ...4..................................... bate .....................r._. Septic Tank (Specify Requirements) . . .. V---O....... .............r----- . / .. ........ ... . Disposal Field Specify Requirements) --- 4 . 0 . y ............_................. ................. ............... ............................................. ............. ......................I................. . ......----...._...................-•---- -........................ ............................:..............;.................. (Draw existing and required addition on reverse side) 1 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 codifies 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 become subject to Workmans Compensaflon laws of California.,, Signed ............. ........... .... Owner By ................... ......... Title .....L��4 tn owner) ..... (if er t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... ....................... . .................... DATE .... ..7_3....... BUILDING PERMIT ISSUED_.;............ . . ....................... ........................... .............. ..............DATE ....... ............ 7 :4 ADDITIONAL COMMENTS............... ...................... ........................ ................................................ ................. .................................. .......................................... .............................................. .......................... .............................................. ........................ .................... .............I.......... ................;...................................1.................................................................................................. ........ NN--- ....................................................................................................... ...... .............. ............ .. ....... '�ina"i"In"'s'p-"ection iw .........................................................................................Date......................................... SAN..JOAQUIN :LOCAL.HEALTH DISTRICT E. H, 13 24 1-'68 Rev. 5M 71711 W