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FOR OFFICE USE, i APPLICATION FOR SANITATION PERMIT 76- 11sV_ _...-. . ....^........................................ (Complete In Triplicate} Permit No. ...._................ :..-...._. ..-`• Y ,ti Date Issued ................ ... This Permit Expires 1.Year From-Datw lszsued .-•--•... ... ,.-.. ................................. Application is hereby made to the San Joaquin Local Health District for .a por'iitiit 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/LOCATIO 0.. cr � .............CE TRACT' ..... .................. . Nsus Owner s Nome ti� •- _= F' ate`"° s Address -..--•--. ...38_.Cee-1- .- � ' ... --.._.. --•...City . ........ .. Contractor's Name ... 'L '� 'l -----••........... ..... License € .. . _:Phone ; .: IrTstdII5_o`n will-sery-e: Residence gApartment House Cornrraercial❑'frailer Court . �. Motel ❑Other ~� --- - ; .... ................. Number of living units:......._ Number of bedrooms ._: .____Garbage Grinder _.__..__.... Lot Size �-�'/..� Water Supply: Public System and name : �, ,� .... vate ............. ._._....,�:..:... ...Pr ffi Character of soil too depth of 3 feet: Sand o Sllt❑ Clay ❑ Peat L_1 �"Sdndy Loam 0..r Clay Loam.❑ Hardpan 0 Adobe Fill Material ............ If yes,type (Plot plan, showing size of tot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer.is available within 200 feet,) PACKAGE TREATMENT I J SEPTIC TANK I J Size....;...... ..................................... Liquid Depth ........................... Capacity ------ -----{------- Type -------------------- Material...................... ,No. Compartments ...................... Distance.to nearest: Well .......................Foundation ...................... Prop. Line --------- ........... LEACHING LINE f J No. of Lines --------- Length of,each line............................. Tota! ;length __._•-••---.....---•---•-•-•. D' Box Type Filter Material _.Depth Filter Material ' Distance to nearest: Well __...................... Foundation ........................ Property Line ....._..____.._.......- !' SEEPAGE PIT [ J Depth .-.-_.`-------------- Diameter _------------- Number'.--•-----____.__._..._...... Rock Filled Yes ❑ No 0 Water Table Depth ...........Rock Size Distance to nearest; Well ....Foundation ..... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit#I { . Data i -w:w 1.(.--- c ;.� ;ry................ r......"Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) .-•- ---�{ G " ` `� ' ------------------------------------------- ----•------------------------ ...... ------ ........... - • .... --•--- ------------------••-•----------------------------------•------------ = - .:....: ...................... i(Draw existing and.requ red addition on reverse side] 1 thereby 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 Son Joaquin Local Heollh:District. Horne owner or llcen- 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 becorne subject to Workman's Compensation lows of California." Signed -----------------------------------� �BY' -• ----- ...�- Owner �, Lf � f -_-----------•-----------•- Title ----- r ................................. ------ (If other t� owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._-. �•;. .i DATE . .............. .6-..-.. BUILDING PERMIT ISSUED ----- -- r �.. ---- ------e......,. ............ •- DATE _ -------------------------------- ------------ ADDITIONAL COMME.NTS ---- -------------------------------- -------- -7 ----- ---- - -•------------------------------------------- -•------------ ----------------------------------------------------- - -- ---- - -------------- -- ------------- ----- . .Final Inspection - ----------------------------•- ----.- � . ..----...---- _. EH 13 2h 1-68 itev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3N 4