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FOR OFFICE USE. ..................................... APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit ....... ............................... .............. . . ..................... ..................................... ....... This Permit Expires I Year From Date Issued Dote 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 rnad p &co ligme with bounty Or roan No. 49 and existing Rules and Regulations. .Tp 9 JOB ADDRESS/LOCATION i..."M ....... ...... ...CENSUS TRACT A��J:77n,� ::Y;7- Owner's Name. .77 - lift . ...........-......................Phone Address ....... city .'Ae.Ab.IV........................._............ ............. Contractor's Name ---c _S, -' -P-&r-/CA! ..........License # Phone ....................... ...... fristollation will serve: Residence)X Apartment Housef-] Commercial oTroller Court fj 'J" Motel 0 Other Number of living units. Number of bedrooms __',2_.--Gorbc!ge Grinder -AC7. Lot Size ................ ........................ Water Supply. Public System and norma •• ...__....------•----....-._..._..........................•....................Privati Character of soil to a depth of 3 feet! Sand i ,k Silt0 CIG'Y 0 Peat 0 Sandy Loom 0. Clay Loom 1-71 �Hardpan b Adobe 0"Fill Miiterlal ............ if yes,type............... ..... ... (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: . JNo septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT f ] I We or -,;. 4611 SEPTIC TANK Size.-C/ ---------....$_.X_--------_------- Liquid Depth ... .............. Capacity TypeMaterial No. .Compartments .....:Z....... Distance to "nearest: Well ..................................z-Foundation ...................... Prop. Line ......... LEACHING LINE No. of Lines ------ 'line" .0 �*...... Length of each --- ....---- Total Length 1-<,oend-,............. V Box .... Type filter Material ..Pi.........Depth Filter Material ... ......................... 00 Distance to nearest. Well ...To---------I... Foundation ........ Property Line .......... SEEPAGE PIT Depth ----- Diameter -----------_ Number ....... Rock Filled Yes 0 No (:1 %A Water Table' Depth ........... ...................Rock Size ------ Distance to nearest- Well ....... ..................Foundation ........ ....... Prop. Line .... ............ REPAIR/ADDITION(Prev. Sanitation Permit# .................................... Date ..... Septic Tank (Specify Requirements)' -------------------------------------------------------- I ..............Is Disposal Field (Specify Requirem6nt's) ............. -------- --------------------- ------- ------ ........... ---•------------------- :---------------------------*......... ----------------------------------------- -------------- --------- ---------------------....... ........................ ............ ...............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 accordance with San Joaquin County Ordinances, State Laws, and sod agents signature certifies the following: Rules and Regulations of the San Joaquin-Local HeafW District. Home owner or licew wing: . "I certify that In the performance of ithe work for"which this permit,is issued, I $hall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ------I......... . ----------------------------------------------- Owner By - ---------------------------------- -Title ... (If other than owner) FOR DE�EARTMENT- :ELSE ONLY APPLICATION ACCEPTEDly ------- ff - E .... .. --------------------- DATE PERMIT ISSUED __.__--------------__--•_-- --- DATE .............. DATE ..... ----- ------------------- ADDITIONAL COMMENTS _7 4 -------------------I------- --------------------I---------------- ---------- ---------------- ---------------- ------------------------------__........... .........1-11............ .................. ----------------------------------- --------------;i I r---- ----I----------- ------�_..'-------------- ---------- ---------------- ........ ........... ......I------ ------------------- ----------- -- - ----- .... --------------------------------------------1................ f-I...........1*11 Final ------- Inspection by -- -----------------------•---..._.-__....._-... .............Date . ................... EH 13 24 1-68 V SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M