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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f (Complete In Triplicate) perNo. ..,.7J.._. ....__!/ •..............................:....................... This Permit Expires 1 Year from Date issued Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein i described. This opplication is mode In compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO T#ON ....- _- _rJ__:. ,. _ . `« ._-_-CENSUS TRACT Owner's Name _.. y� - -- :..---��c?"lei_P,r../.1___�........................... ........._....................-....Phone .-.................-.• ........... Address ............. zP.�-... ,................_.. --_..-._.........-•--. city ..........I......---................................... .._ ... Contractor's Nome ...License# ........................ Phone ........I.................... l Installation will serve: ; Resldence rt ent House{] Commercial QTrolter Court C i 4 Motel QOther---•............:..........:............... Number of living units:--1------- Number of bedrooms .......Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name -------------------------------------•--.........................-..........................................Private V. Character of soil to a depth of 3 feet: Sand L,) Silt Q Clay Q Peat Q Sandy Loam ❑ Clay Loam Q Hardpan 0 Adobe❑ Fill Moteriol ............If yes,type {Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: -(No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT [ j SEPTIC TANK{ 3 Size------------------------------------------------ liquid Depth .................... 'Capacity -------------------- Type --__- Material...................... No. Compartments .................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line .....................J LEACHING LINE ( ) No. of Lines _______________________ Length of each line............................. Total Length, ._..._...................... D' Box ......------ Type Filter Material ....................Depth filter Materlcl"` ..-....:-......................... Distance-to•nearest: Well--..- ............: Foundation.- .......... Property Line ........................ I SEEPAGE PIT [ ] Depth _=------------- Diameter:.._..--_°� .. Number ......................`.._`.- Rock Filled Yes ❑ No Water Table Depth ......... ........................•.............Rock Size .......................... '. Distance to nearest:,Well._._,.._::................................Foundation .._.............-.._ Prop. Line .................... REPAIR/ADDITION(Prev. Sanitation'Permit d&- ---------•...................../.--_-•_-_ .......................... SeptiSeptic c Tank (Specify Requirements)._..:..'.. ..�/ .•_------_�:....��r-4&2- G �T�� . .................1 Disposal Field {Specify Requiremen ) �4 ._ ��................ !' -•- -- -------------------------. ✓••f1"� --:-----------;;...._..--------........-•---•--•--- --•-•-••---•-•----............. .._..._- � � t -----------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 San Joaquin 1 County Ordinances, State Laws, and Rules-and_Regulations of the, Son Joaquin Local Health.District. Horne owner or lion. sed agents signature certifies the following.- "I ollowings"I certify th in the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner as to bee*m subiect to/WJorWn's Cpmpensati laws of California." - Signed Cscls[ C-----'.._.. .?' � -�fv---_•_______________ Owner 4 g rte' i ... Sitle ...................... ................................................. t {if other than owner) } R D TMENT USE ONLY } APPLICATION ACCEPTED BY........ EPc' ` ..........:............................... DATE ...........-..-^_ -��.--7�-- BUILDING PERMIT ISSUED ....... = ...................................................:.......DATE . ......................................... ADDITIONAL COMMENTS . .......:..... ............... .... .... .•--- • -...--..._:_.............------------- .......................... .............. ...........-..................................................•••-.-............ ............. ............................. --- - .Final Inspection bY Date . ---------- EH ---- --Ell l3 2L 1--68 Rev. 5M SAN JOAQUIN tOCAL HEALTH DISTRICT 8/7h ]M