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FOR 5ff!CE USE. ---------- I APPLICATION FOR SANITATION PERMIT ........................ ................... Permit No. _-Z....... ...... 11complete In Trilplicatel ...-•--------•---......-• ........... 1� Doti Issued -----------------------------------------I............... This Permit Expires I Year From Dot*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 made in compliance with County Ordinance No'. 549 and existing Rules and Regulations: JOB (a 9 (-0 e-\(7'tb FIC-L JOB ADDRESS/LOCATION .......................... -----------------------------------*-----------------*.........*...............CENSUS TRACT .................... Owner's Name ------ ...... ............Z...........................................................Phone .3 — 416 2 9 .............•----•-••-•-- ........ Address ........_56 M .I - ------------- ----------- ..................... ......... -------- _,City .....................I...---........._.......---........................ Contractor's Name ----QAF_...... ...... .............. ......License Phone Installation will serve. Residence ff-A-partment House 0 Commercial OTrollef Court 0 Motel [3 Other..._....... ............................ A C 1-�e A Cr_- Number of living units:-- J Number of bedrooms ...3.....Garbage Grinder ............ Lot Size ........ ....r.............................. Water Supply: Public System and name ................... -------------_-------------........................I................................Private Character of soil to a depth of 3 feet: Sand ff— Silt o Cloy [3 Peat Sandy Loam o Clay Loam Hardpan 0 Adobe 0 Fill M6teriol ............ifyea,type ............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed on reverse side. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK ] Size............................. ..............._ Liquid Depth ........................... Copocity _------------ . Type ...... _------ Material---_.._...__ ....... 4No, Compartments .......... ....... Distance.to nearest: Well .............. .....................Foundati n ................. ..... Prop. Line`._....................` LEACHING LINE No. of Lines ......... ----- -------- Length f each line................ ........... Total Length ........................... *D' Box ---------- Type fi ter Material ... ................Depth' Fitt Material ........................................ Distance to nearest.: Wei _----------------_--. Foundation ............. ......... Property Line ......................... SEEPAGE PIT, Depth __J............... Diam ter. ................ umber -------------------- ------- Rock-Filled Yes No (3 Water Table Depth ..-------------.T1------------- .. ....Rock Size ....... ............ ...... Distance to nearest: Well each a Ty P e t. Wei d ... ...... ter .. . .. M \pe Size .Fitt fl Wei .. F J)Iam ............ . ................ --------------"I'll................--..-Foundation __....... Prop. Line ..... ................ REPAIR/ADDITION(Prey. Sanitation Permit# ............................ ------------ Date --•--------•----•----------------_) Septic Tank (Specify Requirements). _..!qJDP......Eq....'Feed` LfAc-14 LiAte 4) Fe---r L, ne– —Jc, ............................... ........................ ..... .................. Disposal Field (Specify Requirements) ------- ............ ................................................. ............. ---------------------------------------------------•- ------ ---------------- ---------------------------------- ------ ------------ --------- ----------------------•-•--•----._.....--------•=•--••....--• ....................................... (Draw existing and required addition on reverse sidel 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, District. Home owner or 11cow 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." Signed ------ - ------------------------ ------------- - ----------------------------------------------- Owner i By -------J_K�n------ --------------------------------------- Title ........ . ..................... --------------------------------------- (If other than ow er) FOR DEPART NT USE ONLY ' APPLICATION ACCEPTED BY -- ---- ----------------4---- ----------------------------------------- --- DATE -,7=7.!!�----- ---- ------ --- -- - BUILDING PERMIT ISSUED ------------I ,-- - ------ -------_--------------------- .......... ---..-DATE .......... --- ------------------------------ ------ ------ ----------- ADDITIONAL COMMENTS -----.-.--•-.+-----------------------•- -_ ---- -------------------------------------------------------------------------------------------- ----------------------------........:.:...-----•-.......................... --------------__-------------------I I ---------- --------------*...... . -- -----------------------------------------------1_1_'1___---------------------------___ ------------�'�_' .. FinalInspection by: -------------I ... ... S------ *----------------- Z ------- EH13 2h 1-68 . .... ............. ---- -------------------------------- -_----_--------Date .... %V. 59144 SAN JOAQUIN L CAL HEALTH DISTRICT 8/7h 3M