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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 ; Cl -in'1rlplle) Permit No. .. ... ......... .:.......................................... R/C V .ompotecat___ ......................................................... This Permit Expires t Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit 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 .._�. 9 �.� l��. �r.e.?��i....��,�,.......... ..................CENSUS TRACT .......................... i Owner's Name ...MC-....►T,.G_ y.. .O_.45 .......-..f-!.........---•-• ...............:......... ......Phone Address ....7.. ? 1/ . -.. +-------a--- 9,,r ...A1&,._W.o,,rAK......... City ...Mc.vv✓4J .A.........I..` .S7. -.Q......:................ Contractor's Name -- /'e�r_r___l.f. ..: `.. a mss. ....... •--- ------•....License # . 5..5! .5! ..... Phone Installation will serve: Residence�rtirnent House Commercial❑Troller Court C Motel ❑Other .......................................... Aces G Number of living units:---- Number of bedrooms '...,_._...Garbage Grinder ............ Lot Size ........ Water Supply: Public System and name ----=----•................................................-....................................................Private 0 o Character of soil to a depth of 3 feet: Sand El Silt❑ . Clay 0 Peat Q Sandy Loam Clay Loam D 0 ,r,..".` Hardpan-❑ Adobe❑• `f..111-Material ............ If yes,type ............... ............ _w (Plot pian, showing size of lot; location of system in relation to wells, buildings, etc. must be placed on reverse side.) 4 NEW INSTALLATION: (No septic tank or',seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK{ j.._ _ Size-=-----•----•............ ...... . ......._ LiquidiDepth ........................ r Capacity ......... ....... Type ------.----_..--. .. Material....•--_-------- .... No. Compartments ....................... G r Distance to nearest: Well - .... .... ..................Foundation ...................... Prop. Line ...................... LEACHING LINE Len F _ [�] t No. of Lines ..-•------- -----• ---. - - Length of each line_______________•------...... Total Length ............................ 'D' Box Type Filter Material Depth .Filter Material Distance to nearest: Well ......................... Foundation ..........r............. Property Line ........................ SEEPAGE PIT ( ] , Depth ------ ----------- Diameter ........__...... Number ............................ Rock Filled Yes ❑ No 0 R Water Table Depth ---------- .....................................Rock Size ....._._.....:__. ........ Distance to nearest: Well ......Foundation" ..................... Prop. Line ................... REPAIR/ADDITION1Prev:Sonitation Permit# ........,. ................................ Date --.----•-- •---................... I ~ Septic Tank (Speci.fy-Requirements) __/� jt7r�tF. .. _o�c�. c.fc.r...TGKk yu� ti /_Zc�c� (r�.Il6H- rG---------- `Disposal Fi`ekl.'(Specify:..Requirements) ..Gram..... Gv C! '............................ ---------------------_----- ..• 1 ------------------------�i--•--1._ . 4.----'-- -----•---,._............---..__... ----•--...'....-----.............-.........__---------F - .._..__.T...._._• f_.•__... _._._ _..._ ................. (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 Son Joaquin County Ordinances, State Laws, and Rules and 'Regulations.of the San Joaquin Local Health l)lstric#.'•Home owner or licen- sed agents signature certifies the following: f` h "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." ) Signed --------•---------------- Owner 1 • .. . ............ xitle _...= other than owner?.,_.,, FOR-DEPARTMENT-USE O f:Y APPLICATION ACCEPTED BY . : ... L :. DATE , 2-,'7-- 7�---------------- f BUILDING 'PERMIT ISSUED ...:-... •. . ...._..........., . .............DATE ---------------•---... iADDITIONAL COMMENTS --------------••--- •--••-- --------------------- ...---•---------•-...._..._...---......:_.................----------................................ .................. --------------------------------------------•- ...................... -------•---------------------------••---------------- ............................................ .................. ---------------------------------------------.....-......................................................................... ................................................ .....---------•--------- � ------------------------------ Final Inspection 6 .._...._.11!�---�- / Z .] ................ p y� ------------------• --•--------...._..._._.....-..-.._.,..Date -----• •-- -..._..._.-.-- ................. EH 13 2L 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M i