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FOR OFFICE USE: APPLICATION FOR SANITATION IT (complete in T Permit No. ........_.............................. Triplicate) ...... .---- .......................................:..... Thts Permit Expires 1 Year From Dole Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to consh d and install the work heroin described. This application is made in compliance wAith County Ordinance No. 549 and ekisting Rules and Regulotlons: JOB ADDRESSAOCnATION .. . ✓.. Y�.... i o,/L(( ........... . .................(ENSU Owner's Name ...Yt .1�} Ytv_. ll! Phone _ -- ..... .............. � Address City ,. a .... .. � dd ...........:... ......... --.------------- Contractor's Name _ a. ----- - --- --- . ........... License # ........................ Phone ...............- T Installation will serve: Residence QI Apartment Houseo Commercial ❑Trailer Court 0 Motel ❑Other- ------- --------------- Number of living units:..... _... Number of bedrooms -....Garbage Grinder ............ Lot Size ...... -----.-- Water Supply: Public System and name .............................-.. . Private [� •- ------•--......----...---•--•-•-•............................... Character of soil to a depth of 3 feet, Sand❑ /Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan 0 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 is available within 200 feet,) i PACKAGE TREATMENT [ ] SEPTIC TANK f Size.../ '/ 7 X...�.�il" 5..,............. Liquid Depth .......� W Capacity .p.u2 -��.... Type Oil--- --- --. MafeMal. 25Q_... No. Compartments ...a ......... Distance to nearest: Well ...........lr'.49-1-?.-----------Foundation ......-1.Q/7-t Prop. Line LEACHING LINE [+f No. of Lines ..A................ Length of each line........1�C,�..... Total Length .-. i 'D' Box ...�-'..... Type Filter Material ----� .. ....Depth Filter Material ....... i.."Z Distance to nearest: Well .......`�' .. Foundation .....!.! /�, i i- -- -, ... Property Line ... ��-r-'..' SEEPAGE PIT (11 Depth .... . S Diameter -, '_-� Number -------..v _ .7....... ..... Rock Filled Yes I—d/No Q n i 0 Water Table Depth ---..............1C.S�.f. / ...................Rock Size .../.�---. rl . ....... 0 Distance to nearest: Well ........... lD.f ..........:Foundation ....� Prop. Line ._5 .._ REPAIR/ADDITION(Prev. Sanitation Permit#.............•......... ........... ...... pate' .......... .................... Septic Tank (Specs Requirements)(Specify R M .:........................................ Disposal Field (Specify Requirements) --- -----•------------------------------•---------....---_...--------•----------•------•---•---------...................... - ------ ---------•..... ....... ............................... ............ ......... .............- ............•......... -------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 Son 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 become subject to Workma s�Compensation laws of California." Signed ,� './J. .. .. . . Owner BY - --. ------- '-�' a f'dJ,.. '�lllff- . Title _ LLd%r-s4clli/.-------------................... pf other than owner) R PARTMENT USE ONLY APPLICATION ACCEPTED BY _C- .. ..._- DATE ..2 ...... _. _ - - BUILDING PERMIT ISSUED . - - ...... DATE . - - - - ADDITIONAL COMMENTS __ - - -- - ----...------- ------ --- -------- --- - .. -- - .. --- --------- -.... ...----- ------------ - -.... ...... ......_ ...................................... ..... ............ .......................... - _.. - -- ............ -- ---- ----- ...... ........ - . ... ..... . ........... . ............._... .. . -- - -- _ - - T/ Final Inspection by: --------- i . ...............Date .- /---z'-- ... -...----... -. ...... .... ...... - ------- EH 13 24 1-68 Rev. 5H A JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M