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FOR OFFICE USE: // id,:3 ° APPLLCATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .......... ... :� ........ _:...._..:.,, .... ................................ ...................... ` This Permit Expires t Your From Dots issued I Bate Issued7.:_y..�`..7 Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. Thi application.is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB DDRESS/LOCATI N ......_ .. . ... ........ . .. .....CENSUS TRACT .........7.. ..3`f -al _ /_s Owner's Name .... . ...0 _. . .� � ... . Address ........ ...... -J,.... L� /ioC�./ ........ ,• •--•--... City ...: ©.......p. e Contractor's Name ___ ' hon �! f 4�...�/ .._�,�1��' T License # % •- e . f Installation will serve: ResidenceA Apme tHouseo Commercial []Trailer Court Motel ❑Other................................ Number of living units:..-/------ Number of bedrooms '...__Garbage Grinder ._ Lot Size .� Q.. -�� ... Water Supply: Public System and name .............. ........................... ...........Private ❑ . _-•---...------........I................ Character of soil to a depth of 3 feet: Sand❑ Silt.❑ Clay 0 Peat❑ ' Sandy Loam 0 Clay Loam ❑ Hardpan CI Adobe Fill Material ..._ If yes,type ' (Plot splan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse aide.) _ NEW INSTALLATION: (No septic tank or seepage-piteperrrtitted-if-public seweris-ovailable-within 200 feet,) PACKAGE TREATMENT € J SEPTIC TANK Size............. .................................. Liquid Depth I ` CapacityType ---- Material...................... No. Compartments Distance. to nearest:-Well es---•--...........................Foundation ...................... Prop. Line ........................ -•--•................ LEACHING LINE:_ No. of Lines "...................._ Total L a "'° �Y-. Length of each IineDe #h .Filter Material Length _. 'D' Sox �- p !........ .................,_ n Type .Filter Material Distance to nearest: Well ............... . ...... Foundation Property tine ._ I . .................. ... . ------ SEEPA� GE PIT ,'( j Depth .....--- -.-__- .Diometer Number _........_•................. Rock Filled Yes ❑ No Water Table-Depth =_` ......::-.:-----. ......Rock Size ................................ i Distance to nearest: Well ...Foundation .. Prop. Line -= M REPAIR/ADDITION(Prev. Sanitation Permit#.-------------.---•_:_---------------------- Date .....:..`-` *`-� -.............) 1 Septic Tank (Specify Requirements)-.,.,...--.-,....... ... .................... . I Disposal Field (Specify Requirements) ........ -........... •--=-----------------------------------------;............... {Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will he done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loral Hsalth.Dishict. 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." 1t Signed --- ----------- ------- - ' ---- Owner BY --`-• - ---------------- - Title - r l .-- c 1 _... (if oche t n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............... . ---•-- ........... DATE ! ..��7 _-Z. BUILDING PERMIT ISSUED ---------- ------ ----•--_--- - -----_- ..__ ADDITIONAL COMMENTS .._._._. 1'... --... 2`' 7..� ��E. DATE �� --------- - ------•--.._...... .......... ------------------- -------- ---- final Inspection by: ......................................................_....................... ate .Zr.f•7�----------. 3 24 1-68 Y• SAN JOAQUIN :LOCAL HEALTH DISTRICT 18/7h 3M