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FOR OFFICE ISE: APPLICATION FOR SANITATION PERMIT [Y (Complete in Triplicate} Permit No. ...44. .. _ This Permit Expires 'I Year From Date Issued Date lssued ..?!.y.`!/..7-Y 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 CountyOrdinanceNo. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .._-. -�. ..1.. ........ ... ._{V ._. ._�_ _ . ............ ...........CENSUS TRACT Owner's Nome .... .. .,. - . . .. _.._ ... e Address ............ ._42..... ...... �..._. .. _.....(.• . City ........... ....... Phone Contractor's Name ..... ...... .. ........ ... .- - icense .. Phone 44�'x a.47.4. Installation will serve: Residence O(Aportment House❑ Commercial '❑Trailer Court ) Motel ❑Other ............ ............................... Number of living unity ._ Number of rooms e ` "Garbage Grinder T�• Lot Size Water Supply. Public System and n .• �- ••......0 Private ❑ Character of soil to a depth of 3 feet: Sand❑ . Silt❑ Clay ❑ 'Peat❑ Sandy Loom ❑ Clay Loam ❑ 4�• Hardpan ❑ Adobe Fill Material _........... If yes,type ____________________________ N` (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepagg pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f 1 SEPTIC TANK-[ &t-S*/'g#ze...........---------------------...------------- Liquid Depth ......................... Capacity .................... Type .................... Material---------------.. -_ No. Compartments Distance to nearest: Well ....................................Foundation ...................... Prop. line ....... LEACHING LINE ( No. of Lines ..__/--_-__-.___.. Length of each line....�P._�_,..------- Total Length .��..�......._.... _.. Type Filter Material .e ....Depth Filter Material �„ 'D' Box ..._ •. �---................._.. Distance to nearest: Well .,/�'. -- Foundation/jO................... Property Line AS7..__........... SEEPAGE PIT Depth --v0S-7---._.-.- Diameter ��•`--_'__-- Number ...._....--••----•--._....._ Rock Filled YesX No Water Table Depth -___-- -----_ ........Rock Size .. .....................-•••- ...----•••••. -•--- Distance to nearest: Well __,�7,g-. ...... ._ _... � - -•-••-•------.........Foundation ,�.(�........... Prop. Line 4—./----------- REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I Septic Tank (Specify Requirements) --- --------------•-----�-----....----......--�-• -•-----------------�-�f-_........ P......Y.- -� P - c .. -•--- • Disposal Field (Specify Requirements) -----------•---•-.-••--�r'� - ------------- -------- _ _ ----`:. . .. - -- --- ---------------- ' -------- --- - ••--••-- ---- . ---------------------------------------------------- ......................................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San 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 .__..._.... ........................................ -----•-•-__.. Owner By ........... � . Title _..... ..................... _.. ---••-•..............: {I other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._-- _-- - .. . �.. .......... DATE .... A 17V.................. BUILDINGPERMIT ISSUED ......!: .S............................ ............... --------------------------------...............DATE --••••----•--•-•---•-•---•--•---- ...... ADDITIONAL COMMENTS ..............•-•-•-----............----------•-----....-•--••------......... .............••••------•-.......-,-•••------•--•----..... .........-------------------------•-••................... ...---••-•••---....................... .................. ----- Final Inspection by: A.................................................. ......... ......--•--••---..............................Date .... .: .. . _.. --•---•--- .._ E SAN JOAQUIN LOCAL HEALTH DISTRICT C►/ E. H.13 241•'68 Rev. 5M -_ 7/72 3 M7�