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.-...................•-••...... APPLICATION FOR SANITATION P"IT . . I i r ( I Permit No. (Complete in Triplicate) ............... .................................. .............. 171- '3- 7 ............ ................................ ......I......... This Permit Expires I Year from Doto Issued 4plicotion is hereby mcide to the Son Joaquin Local Health District r"for a permit `t6 described. this applicon constructanthe work---- ,-....h,a-_f',eI n- on is made in compliance with County Ordinance No. 649 and existing Rules and Regulations: JOB ADDRESS/LOC,AW------- ................ ..............CENSUS TRACT ....... ................... ftL Owners Name I. r ' ... ................. ............... ...... .......... one Address -----------�_,,��/ ......i.......City --------------- --------_-_ ------ Lk — 13 Contractor's No 2e .. .. ... ni .. ... . iiense Y�? / Phone -.41L ........r Installation will tlerve: Residence Apartment House.... .9�merclal oTr6iler Court 4 Motel El Other............ ........;................ Number of livin units:------ --- Nui4 MIN .... ber of Oedroo e Grinder ...... Size ...............I.......... ivate 0. Water Supply: Pul blic System and nc,* Character of soil to a depth of 3 fe 1---------- .. .... ............f.............Pr Sand4il, Slit E] Clay -eat 0 SandyLoarno Clay Loam o A *be Hardpan Fill L Zlol ............if yes,type....... ............ (Plot plan, showing size of lot, location of system In relation to Willis, buildings, etc, must be placed on reverse side.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TR [ I SEPTIC TAMC I.] zt f ---------- ------------- Liquid Depth ............. ....... Capacity ... ---------------- Type ---- Ma- ;-------_----_--- No. Compartments ..............4....... Distan6. to nearest. well ....................................Foundation ..................I... Prop. tine ...................... LEACHING LINE t 1. il, No. of Lines -----------------_- Length of eq' d� line-- ..j.................... Total Length ............................ ID, BOX ............ Type Filter Material -------r............Depth Filter Material .......................... .......... s 4'�i Distance to neare ............ !Foundation. ........................ Property Line ........................ SEEPAGE PIT Depth ................ Aitarrieter Numbermber ..... u -----------_------- Rock Filled Yes No (3 Water'lToble Depth ..................... ....... ..... . To --------J-------_-._Rock Size ............................... "Distan6e to nearest- Well ....... I ------------_-- ............Fo6ndation --- ......... ...... Prop. Line ...................... ItEPAIR/ADDITION(Prev. Sonitcition ------ "D _ I I . - r. -•---•-.-.......------ ate ........... "IA Septic Tank (Soecih Cm .... . ents) ....... .......... !,)I : .........I ............ ..................... 41 . ......................... Disposal Field! Ispecify,Requirements) ---- .....--------_1?e ..................--------- ---------------------------------------- --- ----------- . ----------- '5- 'b- --------- ...... -------- ........... ............................... -------------------- --------------------- -------- ------------11- ------------------------ ..........1..........................I............. arse side) (Draw existing and required- addition I hereby certify that I have piepared this application and that the work wil,I be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the tan 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 lssued,�l shall not employ any person in such manner as to become subject to Worknian's Compensation laws of California." Signed ...................... ..... By --------- --- -- -- Owner ..... - - ------------------------------------------------ f er than owner)- --_- --I--------- Title ----•- FOR -FOR DEPART NT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED --------------- --- DATE -------- ADDITIONAL COMMENTS --------------- --------------- --------*-----------*----------------------------- ------ -------------DATE _............................. ..................... ............ ..... ----------------------------- -----------M....... ...... ---------------------------- ------- --------- ----------------------- ---------------------- ---------------------I...................... ------------------I.................. --------------1_--- ----I-------------------------------- ---------------------_----- -------------------------------------------------•------•--• -•------- ------ ------------ - ------- ----- ----- Final Inspe'dion-by;------ ------ --------- .........._------------ -------- --------- ------ -- _ -------Date 1-68 Hev. 5m M 13 2h e SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3m QD