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FOR OFFICE USE: APPLICATION FOR SANITA'I- ON PERMIT Permit No: 7��7G ...... ........ ................. (Complete in Triplicate) Date Issued . `.73.. .. This Permit Expires I Year From Date Issued ................. Application ' an.Joaquin Local Health District for a per to construct and instal[ the work herein d scr' hi gyps tipa �is mad�an ompliance with County Ordinance No. 549 and existing Rules and Regulations: B AD ... ....... .. .. .... -p � ...........CENSUS TRACT .. ..�._. _.__ . :�. - W ....... .......... .................. Owner',s Name %. 1 ...... .1./V._ . _ .. ............ ,...._... 5 � p Address 4. .r�1 . _ . .�. .:...._._.. City ? .. P ......... .. - .....License #a7 �•---• ' one Contractor's Name ...... _ ` Installation will serve: Residence A",t'House 0 Commercial ❑Trailer Court 0 � Motel ❑Other ................................ ............ ; Number of .living units ......... Number of bedrooms ..�...... Grinder. Lot Size .f!.� �J x_ =/ ......... ...............Private �• Water Supply: Public System-and name ---------------------•••-------........_....:----......_.�__..._...__....•----- --• - to ®� ' Character of soil to a depth of 3 feet: Sand}] Silt❑ Clay Peat 0 Sandy Loam 0 Clay Loam ❑ i �-- - - -.- e _..,__'_..._... i k Hardpan ❑ Adobe iii Material 1✓_. If yes,typ r (Plot plan,-showing-size"of.lot, location of. system in relation to wells, buildings, etc. must be placed on FevNse side.) NEW INSTALLATION:` (No septic tank or seepage pit permitted i sic sewer is available within i hu d200 De ftht!A:7._ ?�_ PACKAGE TREATMENT {:} "'SEPTIC TANK'-[ sae_.._. ..- i! No. Compartments _2� .......... %i Material__ I, Capacity ...��-a'�---- TYPe --�- - '. t .k ne ................... ! # Distance to nearest: Well .._ _� Total LProp ...................Fa a � en th . LEACHING LINE { Na. of lines _._..��_.._.. length of each line _ . 1. ,.� •�---`•�_••-- D' Box Type Filter Material . fl.ui----.Depth Filter_Materiai ._ --• ..:.. ; Foundation a ....... Property Linef---•--...--- Distance t"o nearest: Well _..�----------- -/..•..... Rock Filled Yes-9 ❑ k I Depth ._�.�...R. Diameter .... Number . SEEPAGE PIT [ p 3 - - Rock-siz y f '� L_ Water Table Depth .. _fi --... ........ s ....... (� Foundation .� Prop. Line __��..__._......... 3 ........................... ....... Distance to nearest: Well ._,.... _._. � --------•---•-••.... Date -•------••••...---••••------•----I REPAIR/ADDITION(Prey. Sanitation Permit 96E -.-.---•-•-•--•--,-•- -• - p ----------- Septic Tank (Specify Requirements ................•- ....I........... Disposal 'Field (Specify Requirements) .........................................---------- • - -------------------•-- ....................................•----------.......---•---•-•-----...__.`......... . ----------------- -- .......................................................................... ..... --- ................................... ` ...: ••----------•----------•----------• _....... __.. (Draw existing and required addition on reverse side) I hereby certify that 1 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 San Joaquin Local Health District. home owner or licen- sed agents signature certifies the following: "1 certify that in the performance cf the work for which this permit is issued, Ii shall not employ any person in such manner as to become subject•to Workman's Compensation laws of California." . Owner Signed . ------------- :.....ti.----•--- -----...----- i } ti - ............ ........................ TitleGa_VAv '-- ( other than owner' FR IP TM �USEONLY i.. ✓ DATE . � ..._........ APPLICATION ACCEPTED BY ............. DATE ............................. BUILDING PERMIT ISSUED " .......----•-.................................... ADDITIONAL COMMENTS - . tio ---------•------------•................................•----...----•----..--- Date -- --/- ----------------------- �"� -.- ----.... ---- - Final inspection by: _----•--• - -�-- - -- -•-•-•-=- 4. ... SAN.,JOAQUIN. LOCAL HEALTH DISTRICT. . ., 7/72 3 M -