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FOR OFFICE USE: ............. ................ ................... APPLICATION FOR SANITATION PERMIT ........................... ............ (Complete in Triplicate) Permit No, This Permit Expires I Year From Outs,issued Application Is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is rn de in compliance with County Ordinance No. 549 and existing Rules and Regulations! JOB ADDRIESSAOCATlq� ..wl � [-. . .%40. . .... ... ......CENSUS TRACT�4'9 -o -3D Owner's Name .. ..... k,w..X_ .................................4........... ......Phone ---- --- Address .......(f.....1... .. ... city 7..5....3. Contractor's Name ............. .. .....�- -'Z....SA ..................License # Phone _AdIL-.YQW... Installation will serve: Residence 0 Apartment youseo Commercial C3Trollor Court 0 Motel El Other OUIA.Iid..qe.v4 ........*...... . Nurriber of living units:......_.... Number of bedrooms ............Garbage Grinder Lot Size ........SQ .- l -ply: Public System and name ...... Wafer Sup ......... .......................... Char I acter of soil to a depth-iif,3 feet-I-)Sdnd+ok CIO-------------- ---❑--------------�...... Private 0 Wot Y 0 Poot C:1 Sandy L�arn,6 Clay Loom il Hardpan[3 Adobe Q Fill M6teri+ .... ....... if yes�type.....I.......... ........ (Plot' Plan, showin�rsize of lot, location of system In rotation to wells, buildings, etc, m1i, Placed,on reverse side.) I I I NEW INSTALLATION: No septic to PACKAGE TREATMENT 4 tank or sele-p'aga pit permitted if public sewer is available le I In 200 feetJ f.Iq SEPTIC TANK Size..... ..........I............. ...... ........I....... Liquid Depth .1.......... (2) Capacity ----- Type .......... Material.......-..... ....... lNo--Compartmerft .............. fh Distance to nearest: Well ....... ...... . .. . .. ........... ....Foundation .. .................. Prop. Line .............. ,LE,ACHINGf OW" No. of Lines .. ......- Length of each line.... ............ Total-Length-.................... .......... Pt, it V Box ft Y Type Filter Material ....................Depth Filter Material ........................ ......... M1 L,"4 �,i, ...��! Distance to rt�brest: Well Foundation ........' .I'N ............... a.... PropertyLLjne �-------��: .......... SEEPAGE T De th ......... - ;�` ----- Diameter ................ Number .. ..... _2 L 0 )Rock Filled Yes 0 Wo 1 ... .. Water Table D a pfil .... .. ...... ---................-Rock Size -....... Distance to * nearest:,Well .............i. ...........................Foundation _................. Prop. Line ................ ----------- ---------------- iEPAIR/ADDITION74p�&V—t,;ianithtibFPeiiiilfif'-��l-- Date _..............................J Septic Tank (Specify Requirements) .... .......... .............. .. . .................. • ...................... .........................L......... Disposal Field (Specify Requirements) .... ............. ............ .......... ....... .... .. . .... . ---- ------ - ---- - --- .... . ......................... ............................ ......... ..*..............*....................... ...... Ilk?].... ... ....... (Draw existing and required addition on reverse side) - -- -- ----------*----------- - .............. ............ ..... ........I-------------------------------------------------- ..... I I hereby certify that I have prepared this application and that the work will be done In accordance with Sam Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Itecifth,Disfricl. Home owner or licen- %e_J 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 become subject to Workman's Compensation laws of California." Signed .............I. ......r --------- ..........................- Owner By ..... .. . - ..... .. I . ........ ..................................... Jitle it oth r an owner) FOR I EPARTMENT USE ONLY APPLICATION ACCEPTED BY .............. ......................------ ..... .. DATES ........BUILDING PERMIT ISSUED - - -- ----- ..... ....... .... . ....* - - E ... ----- ----- .. .....ADDITIONAL COMMENTS . . - __ - -I...... ................................,.. ... . . .. .. . .... .......... ........ .. ................. ........ - ----- .. . .... .. ........ ..... Final Inspection by: . . ........................ ............. Date.... ......*......... -13 24L 1-68 IL-v. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT V 8/711 3M