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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. Permit No (Complete in Triplicate) ..-----•..............................I... Dote issued ..............-..:. This Permit Expires 1 Year From Date Issued v Application is,hereby made to the Son Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...:; _. � .- ��D_�=••�- ........ TRACT .....................:.... Owner's Name ....................... :.....................Phone ........._......................... _ r Address ..... d r City . ....--- ...�� r ................................... �2 -® Contractor's Name& _&A(6(eM- --------- Installation ---- -- License #��03�G__._._.... Phone .............................. Installation will serve: Residence M-A-pa`rtrnent House❑ Commercial ❑Trailer Court ❑ ¢' Motel ❑ Other ---------------------- - r ,//� Number of Living units-----):...--. Number of bedrooms ......Garbage Grinder --.___-___ Lot Size .....�..(_!�_4i............ Water Supply: Public System and name ...---_---_ ---------------- ...--------------.:._........Private ❑ Character of soil to a depth of 3 feet: Sand Silt F1 Clay E3 Peat❑ -Sandy Loam ❑ Clay Loam ❑ t Hardpan ❑ Adobe-❑ Fill Material ............ If yes,type -----_---------_--------- (Plot ----_----------------•--{plot pian, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within.200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK Size..-_ /............ Liquid Depth. . __ ..-'--.• eNo. Compartments � Capacity/6 Material. .._ )stance to nearest: Well -----/00.'...............••_Foundation s.......__.. Prop. Line .� length of each line--- - -----------• Total Length ... 144.............../-.._. ... �- LEACHING LINE [ No. of Lines _.. .______. D' Boxy Type Filter MaterialS�•WDepth Filter Material ---- -A Prop G f - �,; .�. a._._ _ Property Line .. 4 Distance to-nearest: Well ._ ��..Fougdat•ion ,_��--r--,_-a_ 4'� ----• , SE01146"IT Depth -.. Number .....4--- Rock Filled Yes ar- No rnl - Water Table Depth t------------- -------------------Rock Size ...---------....1.....------.II-- Distance to neared We I� ...Foundation _.<.l� e!+... Pro Line ` .. - REPAIR/ADDITION(Prev. Sanitation Permit k# _ .-•-•--------- ••..... • Date ................ ..................) CA Septic Tank (Specify Requrements) _c � ....- - .. ... ......-. -------- Disposal Field !Specify Requirements} ......................... :.. ;... ._. _. •. --- ----------------- ........................ -------------------- ..... (Dravu:existingand required .... �.-;. q edition on reverse side) I hereby certify that I havelprepared this application and that the work will be done in accordnce ith San .ioaquin County Ordinances, State Laws, and Rules and Regulations-of-the Sa"oiit{uin.,Local Health District. Home owner or licein- sed agents signature certifies:the following: L., -� "1 certify that in . performanc f the work for which this permit is issued, shall not employ any person'in such mannas as to beco co ori a s Compensation laws of California;" - Signed _ --- ....... ........ .....•----. . ......................................... Owner !, ...---• .Title ... ........................................... By .....:...................... ......_...----------------------.._._...... (If oche than owner) n FO DEPARTMENT USE ONLY _ :...... __...... DATE......&- ................ "'f .... � ---.. APPLICATION ACCEPTED BY....----- BUILDING-PERMIT-ISSUED—�_________ _ __ - - A ................. .- -_-.:....€_. .. . ADDITIONAL COMMENTS :. -....................... ..............•-------.......I....--- ........._I..•-----......::. . -` .................--:._.:` --------------------------- ------ -------.:7........ ....................................... ..... --- .._..... .. .. ..'. .�i" ..._............._. y� . Fina) Inspection by: ....Date -. ' " SAN JOAQUIN LOCAL HEALTH DISTRICT t ,� 13 24 io o_., caa 7/72 3 M _