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FOR 6k ICE USE: APPLICATION FOR SANITATION PERMIT ...................................................... (Compl;41in Triplicate) Permit No. ................... This Permit Expires 1 Year From Date Issued 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: J08 ADDRESS/LOCATION . C•i�� -• •� CENSUS TRACT/.. ...... ..... Or Owner's Name ..... .. :27 ..... .......... ..... . . ......................:...W...Phone.1 ' .�1�' _.. Address ........................... .... ... .... .. ....... .. . .......... .. .......................City ............................................................................... CtSniractor's Name ... c. �.... . . ......... '--•------•---..............:........License #4.7fai..24. Phone IZZ................ �3'cf Z ',installation will serve: Residence❑Apartment House❑ Commercial(]Trailer Court ❑ _ I Motel ❑Other ......... ............................. Number of living units:............ Number of bedrooms .2_4d, Garbage Grinder Lot Size G% �� -Q� ....... .......... ..... .Water Supply: Public System and name ................................:........................._.....................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy,E] Peat p Sandy Loam ❑ Cloy Loam ❑ Hardpan❑ Adobe j� Fill Material .... yes,type ............................ ti (Plot pian, 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 if public sewer is available within 200 feet,} ! .A PACKAGE TREATMENT ( ) SEPTICTANK] ] Size.............................:.................. Liquid Depth ..................... ` Capacity yp ....... No. Compartments T e .. Material.........::.. --= �.:...... 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 f Distance to nearest: Well ....................--,Foundation ........:.:............. Property Line ........................ SEEPAGE PIT Depth ', Diameter .......:........ Number ........,.... .............. Rock Filled Yes No. rn [ ) p ......... ........ fl ❑ Water Table Depth --------•--.......... ._ r ......Rock Size ................................. l-• Distance to nearest, Well .___...Foundation ... Prop. Line ' REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. 7 Septic Tank (Specify Requirements) ..-- ............................w.........._.._. •-- .-- . �-------------•-.`•Disposal Field (Specify Requirements) .. •---••---•--------------•••-•... ......................... y ...................................... ..........t...........A:-..-.--...-...-..-•-----•---•----:._........................ --------------- -- -.- '":_._._..... :.............------.................. (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 San Joaquin local Health District, home owner or licen- sed agents signature certifies the follpwing: - "I certify that in the performance of,the work for which this permit Is Issued, I shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." Signed a . .: ................Owner B .....<? ... ......................_ . Title .....G:�/lA.n............... (If other than o eel g DEPARTMENT, V NLY + APPLICATION ACCEPTER BY.. .Lu.......:. .:...1204�. .O.A-r--,Z ...,DATE ........ BUILDING PERMIT ISSUED .. .... .... ........ .......... ....:...::. ......._........_... ....:........:.:...DATE .........�..... ..---.............. l,! ADDITIONAL COMMENTS ,.. .. ..... .......................1.... ... -- - -'. ••........_..... t� ..... . 5'1 �/ /" ... ...................... ! ........... ....•.... Final Inspection by; ............................. ........... . ..........._....Date ..... ------7 --- SAN_JOAOUI �LOCAI. ALTH DISTRICT ......i. _. .. ... -_ _ _. _ . . . _. A F. H. 3 24 1-'AA Rwv- 5M 7/723