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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: 7._O-�,� r ------------------- ..-_.. --------- This Permit Expires 1 Year From Date Issued Date Application is hereby made 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 Cciunty'Ordin6riee No. 549 and existing Rules and Regulations: JOB ADDRESS/LO ION alas----.- C e�rQ T Z ENSUS TRACT .. r Owner's Name O�M- , Phone. .... . - Address . . ...t� 'Z . ..T` 1�. - .... - . ..... ....... QLD�►i ... .......... ..........---- Contractor's Name.- -- ....License #�y 38Y.... Phone ...................-....._ - - __ Installation will serve:4 Resi ence [Apartment House❑ Commercial❑Trailer Court I❑ t � Motel ❑Other --------- ......................... --------- Number of living units:- __ Number of bedrooms ---4.....Garbage Grinder --..�...._ Lot Size ./7`t76.**-. _710a.,-..,, Water Supply: Public System and name .. ----.. . . Private Com/ Character of soil to a depth of 3 feet: Sand❑ Silt[] Clay [I Peat i] Sandy Loam Clay Loam [] Hardpan ❑ Adobe 0 Fill Material __ ------- If yes, type ------- -................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placedon reverse side.) NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK 4 1 Size s1 /.P.. d 6....,,•;♦ ..... Liquid Depth ;._... Capacity - ---- Type Material. I/ No. Compartments+-zr........._..... Distance To nearest: Well er'3.'--.- r 9 Foundation _.....LB........._. Prop. Line ..._`r.-:.,._.__. LEACHING LINE [ No. of lines :3.aZ.-------._---- Length of each line.......7j................. Total Length ............... 'D' Box ... _....y Type Filter Material . S-A Filter Materiae.../..9. . ...� ---.. _ _ Distance to nearest: Well .::---_ e 7.......... Foundation ..._.1.4..I-------..._ Property Line -. �. Depth -------N�-----.- �ter.�.`-11'-.10--- Number ---.--o?r..--'--�--. Rock Filled yes,�No .❑ Water Table Depth --------.... -...... --'---........Rock Size X 3 ........Foundation �Q__....... Prop. Line .-......... Distance to nearest: Well _ '-_.:a..�em'•.::.` r �- +� r � REPAIR/ADDITION(Prey. Sanitation Permit# .................-_.____.._%------- .... Date -------------:.................... ) Septic Tank (Specify Requirements) ....... ............. It '.. ..................................................... --.................. Disposal Field (Specify-Requirements) ...............................-............ ... �).t...,..:....,. +ti ..._...� • / (Drawexisting•and-required addition on reveise 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 Joar{uin Local Health District. Home owner or licen- sed ager¢'; signature certifies the following: I 1" "I certifylthat in the performance of the work for which this permit Is (ssu ed, I shall not employ any person in such manner as to become svb)ecf to Workman's Compensation laws of California." , ' ? Signed - - -- - Owner' - By --_........_.. . . . .. .... .. ... ... ... ... ............ Ir.I ................ Title _►�zax .a ---- -- _ --------- ---- (If other than owner) s FOVDEPARTMENT USE ONLY APPLICATION ACCEPTED BY . - - ----------- - ..... ............................. DATE ------- BUILDING PERMIT ISSUED . - - DATE ..._. -.-. - ADDITIONAL COMMENTS . -h ��P'�s ` ' - - --••-•-----I---- -'------ --'----------r ............... ------ ------------------------ -- ------ - ------- ----- ---------------- I- r----------------------------- ..................... - -= f ._....._... - - Final Inspection by: ._ -- - -------------------------- -- ------ .........Date -- -�11----------- --•------- SAN JOAQUIN LOCAL HEALTH DISTRICT