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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT t lComplete In Tripllcato3 Permit No. 74/- ` = l Date Issued .......f.... .. ' ...-----•--•-••-•---•..............•_:......--.•----_---. This Pernrlt Expires 1 Year From Date Issued 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 County Ordinance No. 549 and existing Rules and Regulations: - JOB ADDRErSSAOCA 2 _ ...�-�..�.]---f�-•- ...,.... N. �/_ _... .....................•---..._._...........CENSLfS TRACT ................ Owner's Name C� v .1..- 7J/ p' .- '......... ............. .......................Phone =.,._...... ...,.;...__....--- Address ................. ' /v••G� � .: City ......... .. ._�/ Contractor's Name ..... d-... '------••------.License . - -/Phone -------------------------- Installation will serve: ' " :,..° Residence. partment-HouseQ_Commercial OTraller Court 0 Motel ❑Other Number of living units:------- Number a ooms . ...Garbage Grinder . Lot Size /! .l.r�.... J �— {J Y Water Supply: Public System'and nam "''�� CTS ...................... .............__._.._Private ❑ w Character of soil to a depth of 3 feet: Sand T_1 ilt❑ CI y ❑ Peat❑ Sandy loam ❑. Clay Loam ❑ \e i Hardpan❑ Adobe Fill Materiae If es e V F (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 1f..pubiic sewer.is avoiloble-within-200 feet,) f� PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size.......................................I._...... Liquid Depth .............:............ Capacity ------------------_ Type -•---•---------•---- Material---................... No. Compartments ...................... Distance to nearest: Well ....................................Foundation Prop. Line ...................... LEACHING LINE [ ] No. of Lines ------------------------ Length of each line............................. Total Length ............................ 'D' Box ----------- Type Filter Material ....................Depth .Filter Material ............................................ Distance to nearest: Welt ........................ Foundation ........................ Property Line ........................ fSEEPAGE PIT { ] Depth -..:'4-------------- Diameter ................ Nunhber -.-_.--:------... ... Rock Filled Yes ❑ No 0 k Water Table Depth ----..............................-------_----Rock Size -.................... -•--•- 4 Distance-to nearest: Well.---:.-: ____— :_: —:T= Founddtiorv— Prop:"Line ...........:.......... t s DDITION(Prev. Sanitation Permit _ Date REPAIR A v. n _. . _ ----------------------------------� Septic Tank{Specify Requirements) ................................. ...•- ....../.---........ ..__._...___.__......---.-.__......._..................... Disposal Field (Specif Requirements........... ........- '`�:y.__ --_--•• ---- -------------•- - -•----------- .................._. ------------ •-•--••-- ...................,........................ = = ._---------------- --------------•._.-----___._____--- -..--------__-----•_-_----= ---..-.-___- t (Draw existing and required addition on reverse side) i I hereby certify that 1 have prepared.this..application,.and.that-the work-will.be-done.In_accordance with San Joaquin i County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health:District. Home owner of 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 ----------------- -----------=- Owner - '„, !'+ � ------------------- Title ---- B mac' Of� c (I of r than owner) , F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----7--7- ----- --- -- •-----..DATE _. .. .._. BUILDING PERMIT ISSUED ----- - r-- -- -------------------- --- ..... -----_---------.-... ....DATE ........ _.-.........---...... ADDITIONAL COMMENTS -------------- _------ 7 - ..._..._ --------------------------------------------- ---------•- --- -- - ------------------------------•- .. ------ --------------- ......................................... ---------- ----- ......_....... --------------- ---- '..:. . ......_ _.. _. ... . ..�1..,_ F ter.._..., Final Inspection by: --- - -------------- ' ...... _...:... Qate .. .. _....... ........_.:.. .........._... EH 13 24 �`�� f SM SAN JO QUIN LOCAL , ALTH DISTRICT 8/7h 3M �,