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FOR OFFICE USE: APPLICATION FOR SANIVATION PERMIT dtise ............. ... ....... ...... .......... ........... ItNo. ..17- -2-" (Complete Im TrIplicate) pffm ............ ..................................I................ ................................I........................ ThI% Permit Expires I Year From Date Issued Date issued ... Application is hereby made to the Son Joaquin Local Health District for a permit to consfruct and install the work honell clescribscl. This application Is made in compliance with County Ordinance No 549 and existing Rules and RogulotIOM JOB ADDRESS/LOCATION TRACT ....06.. Owner's Name ..... ..........................phone 3_ _ ....... ......... ........ . Address f Contractor's Ncme ..,4a-C.57,e . .. .. .. ...... City -C... ................................ ......................License # 3PT!?.qf..... Mone 5 99 9'4'M ".1stallation will Residence Ej Apartment Hou 31 r7rollor Court 0 erci4 Motel;KCither.... ..... ........ Number of living units. Number of bedrooms ..Q......Garbage Grinder Lot Size .. ......... ............... Water Supply: Public System and name .......................................... ........................................................Prlvaft Character of soil to a depth of 3 feet: Sand Silt[I Clay 0 Peat 0 Sundy Loom 0 Clay Loom E3 Hardpan E] Adobe 0 Fill Material............ if yes,typo............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse 0 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 fositj PACKAGE TREATMENT SEPTIC TANK{ J Size............................................ Liquid Depth ..................... Capacity ILR100...... Type/.14�Cd#-524. No. Compartments —7........... Distance to nearest: Well ....................Founclatior ............ Prop. Line ......... 101 4 -e LEACHING LINE No. of Lines ....... ....... .. LenSlh of each fine...._? ....... ...... Total Length ....P.0.................... 'D' Box ...... Type Filter Material 113-.............Depth Filter Material .—N* ................................. Distance to nearest: Well ..,/.3.d........... Foundation ./.3-.............. Property Line .......... SEEPAGE PIT Depth .. ..—.......... Diameter ....!77. Number ..................... Rock Filled Yes 0 No 0 Water Table Depth ..... ..... .......................... .......Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Parmif# ........ ................................... Date ................................. SepticTank (Specify Requirements) ......... ... ........................................................................................................................... DisposalField (Specify Requirements) ......................................:.................. ........................................................................... ... ....................................................... .............................. ................ .............. ...... ...................................... ...................I...... Mir - - - -------- ---- ............. . ........... .................... ... ...- (Draw'ex'is*ti-nga-n,d,reo'u i red'odcl'itfo'n'on reverse side)...*......**.......... .................................... I hereby certify that I have prepared this application and that the work will be done in accordance with Son J"qrAx County Ordinances, State Laws, and Rules and Regulations of tht Son Joaquin Local Health District.Hame, owner or lkew sod 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 object bject to Workman's Compensation laws of California." Signed ...... ... ... ............ .. . ......... .-......... ..................... .. Owner By .... Title (if other than owner) .... .................... _Rjf�"ENT USE ONLY APPLICATION ACCEPTED B) , 40 ............................... . .......... DATE / lc;r76... .. ... . BUILDINGPERMIT ISSUED ........ .. .. ... ................................... ............. ................... .......... ...DATE . I............................... ADDITIONALCOMMENTS .. ........ . ... . ..................................................... ... .............................. .—I ......................................... .. .... ......... . .......-......L. ..... . ..... ............I........ ................................. ...... ........................... ...... ..I....... ...... ... .. . ... . ... ...... ..........—.—..................... .... .. ....................... .........I........ . �; ... ........... ...............................I.....I ...... Final Inspection by: .... /1", ........... .... . ....... ..... .... ......Date o�//i/7-46..................... EH 13 2L 1-68 SAN JOAQU!N LOCAL HEALTH DISTRICT 8/7h 3M