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FOR ICE USE: APPLICATION FOR SANITATION PERMIT /7 Permit No. (Complete in Triplicate) ....................................•..................... ...................... .......................... This Permit Expires 1 Year From Date Issued Date-Issued Applicatiori 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 4ZO ..... 4 _ - _e ...............CENSUS......CENSUS TRACT .......................... Owner's Name ...... ......... --------------- .....Phone ................................ Address ......... • ------------ ............. ..... City ......................... .................... Contractor's Name ... X6" :.License # Phone Installation will serve- Residence 2Apartment House 0 Commercial E)Trailer Court ❑ Motel E] Other -.-___,r_--.-•--•---'- Number ---- --- -------- Number of living units:... ------ Number of bedrooms .....,t2___Garboge Grinder Lot Size .446rA?A1 Water Supply: Public System and name . ---------------- I. - ------------------ ...... ---------- ------_---_----------Private El Ch dracter of soil to a depth of 3 feet- Sand 0 Silt 0 Clay .1 Peat C-] Sandy Loom ,C] Clay Loom 0 Hardpan E] Adobe Fill Material ............ If yes, type ------ t3(Plot plan, showing size of lot, location of system in reJdtion to wells, buildings, etc. must be placed on revers side.) j NEW INSTALLATION: lNo,septic tank or seepage pitp .:, ermitted if p6blic sewer is available within 2003 feet,( � I PACKAGI! TREATMENT ,SEPTIC TANKSize..........11-------- I - - l.l!. ----------------- . Liquid Depth ......................... Capacity Type ...... ............. Material .............. No. Compartments --- ............ Distance to nearest. Well ...... ................Foundation ......... Prop. Line ................. ............. LEACHING LINE No. of Lines ... Length of each lii'line ... Total Length 'o 'D' Box Type Fi Iter Materia I ----------Depth Filter Material _1_19...... -------__---- Distance'to'nearest: Well _..--------------- Foundation ... ...... Property Line _e......._.._. SEEPAGE!PIT Depth Diameter Number ... Rock Filled Yes Q] No C] Water Table Depth ........ ........ .....Rock Size .. ... ............. Distance to nearest: Well .........777=---------i:.----Foundation il Prop. Line ---wO_............ REPAIR/ADDITION{Prev. Sanitation-Permit# ........................ ------------- Date ----------------------------- Septic Tank (Specify Requirements) ................ ............... ................................ .................. ------------------ Disposal Field (Specify Requirements) ....... - ------------------------- ---------- .................. .................. ................. ........... ........ ............ ......................... ....... ......... .............. (Drdw existing and required addition on reverse side) I hereby certify that 'l-have prepared this application andthatthe 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 Workman's Compensation laws of California.",, Signed .... ............. ....... ......... --------------- --------------- Ow 11 ner By litl e ........ ....... (if other than owner) t FOR DEPARTMENT USE"ONLY APPLICATION ACCEPTED BY ....... --- --------- - ----------- ------- DATE ...... ............ BUILDING- PERMIT ISSUED JJL - _. - I . ........ - -------- -----DATE ''..'1.-- ..................... ADDITIONAL COMMENTS . 2--------------- .........................................................-- ........................... .........._1------- -------------- ------ .. ........... ----------------------------------------------------- -*....... ..........._-------- ............ .... ...... . ....... ... ................ ....................... I _ �::------**.............. ........ .... .. . . ....... ........... Final Inspection by; . ........ ... - ------ --- --------------- ....... --------------_------Date HE SAN JOAQUIN L08 AL AL HEALTH DISTRICT E. H. 13 24 1--68 Rev. 5M . . ...... 717? �;