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FOR OFFICE USE: APPLICATION FOR SANITATION MMIT – ` (ComPermit No. . (Complete in Triplicate) ................... .29 7S_ ' This Permit Expires 1 Year From Date 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 compliance with County Ordinance No. f549 and existing Rules and RegulatiGnsi JOB ADDRESS/LOCA ION I cf !......� �X-1C� U I 1{ f ' . . . CENSUS TRACT ............ ............. Owner's Nome D q o '. .. s............................ ..r.. .. .. ....... . . . _...Phone . �c �5 Address 1 .�t Sr �'I "41A; it ... ....... City S--SCP...V. ....Phone I cit,46" T, ............... Oyu Contrector's Name �,4ed41C— c�� . ... ... .License Phone ik.../..�:�,�+�� Installation will serve: Residence Apartment House❑ Commercial []Trailer Court ❑ Motel ❑Other . .... ......... r Number of living units: I Number of bedrooms ....Garbage Grinder )C 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 p 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 side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK O Size... . ................ Liquid Dr.pth ..........................J Capacity Type Material. No. Compartments ......................00 ` Distance to nearest. Well .. .. .... ... .Foundation . Prop. Line ..................... LEACHING LINE ( J No. of Lines length of each line Total Length -s ++ 'D' Box Type Filter Material Depth Filter Material Distance to nearest: Well Foundation Property Line . .............. 'A SEEPAGE PIT O Depth Diameter ................ Numbe Rock Filled Yes ❑ No C1 - Writer Table Depth ...........................Rock Size __.. ... ... ... .........P Distance to nearest: Weli .......................Foundation Pro Line ...................... REPAIR/ADDITION(Prev. Sanitation Permi•# . .. Date . .. ....... ....................1 Septic Tank (Specify Requirements) ....... ...I. .... ..... .. ...... ........................ ......._ Disposal Field (Specify Requirements) . f If �/ )-;Ne /r'. / .. SPP, eP11. .... ... ...,� (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 Iicen• 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 beco subject�fo V)Ip►kma '✓ompensation s of California." Signed , 6, ✓� 'LOwner Title If other than owner) FOR DEPARTMENT USE ONLY DATE' APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS Date Final Inspection by: `.75. ��.• •.- SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 7172 3 14 E. H. 1•'68 Rev. SM – - --�' ---eta