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FOR OFFICE U E-, L APPLICATION FOR- SANITATION PERMIT t. (Complete In Triplicate) This Permit Expires I Year From Dotia Issued .; Permit No, Date Issued Application is hereby mode to the Son Joaquin Local Health District for a permit to construct and Install the work herein described. This application is ma$Ide in compliance with County Ordinance No. SAO andl existing Rules and Regulations. JOB ADDRESS 'LOCATION., �v� an , .......q��F CENSUS TRACT Owner's Name/:1 ................ ............... _......Phone ............... Address )P,7,C0 . ....... ...... ...... -__ - --------- - -- - ------- city Contractor's Nome Installation will serve. -Residence (l Apartment House CQ Commercial OTraller Court Z -- Z/ )V r )- 0 -Motel Cl Other ........0.� V �q *, I Number of living units-..../ Number of bedrooms ..,_...Garbage Grinder./ ,rf�;Lot Size ...... Water Supply: Public System and name . ....... ...... --- .Privote ;& Character of soil too depth of 3 feet: Sand j] Silt Clay Peat[:) Sandy loam o Clay loam c] Hard oon M Adobe & Fill Ma'terial . ... .... .. If yes, type_ ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) A NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) PACKAGE TREATMENT SEPTIC TANK Liquid Depth . ........... Capacity 1,2_47V_ Type�st� . materlol.ako/le #.1 No. Compartments Distance to nearest: Well Foundation Prop. Line _.,?0 ........... LEACHING LINE No. of Lines Length of each Iine,_.,7.,0 .......... Total Length . ..... - b 'D' Box /f/P. Type Filter Material /6-% 046epth Filter Materialr..__..__...c...................... Distance to nearest. Well._ 5 447........... Foundation Property Lim ............. SEEPAGE PIT Depth ..... Diameter Number Rock Filled Yes No (3 Water Table Depth ............. Size ...... Distance to nearest: Well .......... . ... Foundation Prop. Line .......... REPAIR/ADDITIONiPrev. Sanitation Permit# .......... ............... . Date ................ ...... I Septic Tank {Specify Requirements) ......... ... ............... - ......... Disposal Field (Specify Requirements) ....... . ......... ... 1 ....... . ............................. ------ . ....................... .........................._............._..__.s................ _................. ........................ ................. - - ---- ------------ ........... I .......... I .......... ..................... ......... .............. ........... -------- (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 actordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Lotall fjoialfhi DisMet. Homo Owner or licen- sed agents signature certifies the following - "I Certify that in the performanto of the work for which this permit is issued, I awl Imt, liampley any porse#% in such wAinnet as to become subject to Workman's Compensation laws of California." Signed............. --------------------------- * -------- Owner By litle --.-.-I......._..... Ifif than wner] IDEPARTMENT USE ONLY ........................... . APPLICATION ACCEPTED BY... .................... ___ .......... ...... DATE_ BUILDING PERMIT ISSUED ____ I .. !, -.1---1 ............ ................. _ ............ ADDITIONAL COMMENTS.... .... ... .. ... .... .. ..... ....... ............ ........ ............. A. .......... ........... ....... -..---.1.1- ........... ---------- .......... . . .......... ------------ ........... ......... ........ ........ ...... ... . ...... Final Inspection by.........................------------ ................ ___.Date JOAQUIN LOCAL HEALTH DISTRICT E. H, 9 3 -'68 Rev. 5M,