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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT Permit Nn. .Tz`". (Complete in Triplicate) " '�'. id This Permit Expires 1 Year From Date Issued Date Issued ..v c...(.....Z.�.- '; t , W Application is hereby made to the Son Joaquin Local Health District for a pe-mit to construct and '+nstoll the work herein described. This app!ication is made 'n o pliance with County Ordinance No. 549 and existing Rules and ReflulaTions: JOB ADDRESS/LOCATION/�S%Dt�Of��l�y.� O...�:.D...tl._.pF/ALBS/21/..A-V,....._ CENSUS TRACT .......................... Owner's NameL!.Q`'��.... G� N .....,�fA57................... ....... .............Phone. �? Address .-47mlz.� . .. ..........................................................._.....,.....city /�/�1V!7ZV. Contractor's Name ._......-•...................Ucense ...;Phone.!l �. •: Yf. installation will serve: Residence❑Apartment House❑ Commercial []Trailer Court 0 Motei Other L=1 !iEG��f............. ; Number of living units:............ Number of bedrooms _..---.Garbage Grinder ...... Lot Size :. .:/ .. :..: i Water Supply: Public System and name ....................... ..._........._._......._..........................................Private y Character of soil to a depth of 3 feet: Sand y3 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Q: i Hardpan❑ 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 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPT!C TANK,(] Size' J!. X..�- .fy...�......... ..:..... Liquid Depth, k CapacityCr2i Y-.- Typef� ;040 Mater�al�G�No. Compartments 11 Distance to nearest: Well ...j."0.-- ..............Foundation 1,:52............Prop. Line LEACHING LINE No. of Lines ....--J........... .. Length of each Iine..IX.._....._....... Total Length 'D' Box e .. Type Filter Material ......Depth Filter Mate ............ Distance to nearest: Well .............. Foundation ./G'................ Property Line .......... SEEPAGE PIT [ ] Depth .................... Diameter _............... Numbe• ................ ........ Rock Filled Yes Water Table Depth ................................................Rock Size ........._..................... _ Distance to nearest: Well ........................................Foundation .................... Prop. Line: .. REPAIR/ADDITION(Prev. Sanitation Permit# ........ .... ................._.__...... Date ..............................—.1 Septic Tank ISpecify Requirements) ..................... _.. Disposal Field (Specify Requirements) ..... .......---.................................. ............... _................ .... ..... ...__ . ........ .. ........ ........... ........................................ ................ ........... .............. _......... .. ... .... . ..... rx .. (Draw existing and required addition on...re.verse side) I hereby certify that I have prepared this application and that the work will be done in accordance will: San Joeq' �r County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health Cistrict. Homy owner or 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 mem as to become subject to Wo:kmar) ,Comp� c•n I ws of California." Signed . .. '. Own_ f /G _ Pr " i ... . .. T:tie (If 0thr than owne!`'- FOR DEPARTMENT USE ONLY 4 _ �' APPLICATION ACC_r.ZD BY 'b'� DATE .. BUILDING PER!Al r ISSUED _ ADDI•(IONAt COMMENTS ... .. ._ ._ ._..... . .......... . ................... .......; t.. . . - . . a Finoi Inspection by: ., v .z. SAN JOAOUIN LOCAL,HEALTH DISTRICT <t E. H. 9 1-'68 Rev.r5 r ........r -... ., .