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'FOR F OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------ ----------------------------- 11 . � I . .1 - :Permit No, (Complete in Trip -licate) -- --------------- --------------------------------- D ---------------- ----------------------- --------- K (r This Permit Expires I'Year From Date Issue ate issued -- Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This applicatioA, is made in compliance with County�Ordiinance No. 549 and existing Rules and Regulations.. 7-1 JOB ADDRESS/LOCATION ENSUS TRACT -------------------------- ----------------------------------------- Phone Owner's Name ----1W11,---------- ------- - ----------- Address ------------------51-6y-.CF-------•-- ------ city ---------11?Z:21i ------ -----'---------------- - Contractor's Name ------- Phone ------ ....... - --------------------License # 074�-Y/-�r Installation will serve: -ResidenceApameht House,[] Commercial .[]Trailer Court -.0 1 4 AApartmentIt Motel F-1 Other -----------------i--------------------I-------- I J. klum'be' r of living?units:----- -/-- Number of bedrooms -,.<777_Gcirbage Grinder l -'-,Cf -- Lot Size ------ ---------- Water Supply: Public System and name -------- --------- ----------------- aze;--------------------------------I------------------I-----Private E-] Character of soil to a depth of 3 feet: Sand'E] Silt E] Clay E] Peat F] Sandy Loom -E] Clay Loam E] Hardpan F-1 Adobe*' Fill Material If Yes,type ---------------------------- d (Plot --------------- ----------- (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 availcible within 200 feet,) PACKAGE TREATMENT SEPTIC TANK ZXt457�ize----------- ------- .••------------------'----- Liquid Depth --------------__----_ -_-- CapacitY -------------------- Type --------------------- Material ------------------- No. Compartments ---------------------- - Distance to nearest: Well -------------------------------------Foundation ..... ---------------- Prop. Line -------- .............. LEACHING LINE No. of Lines ------------------------ Length of each line--I---------------------- --- Total Length ----------- ---------------- Box ------------ Type Filter Material ____________________Depth Filter Waterial ____________:___________________--._.-.-- i -Distance to nearest:'Well --1----------------'--- Foundation- Property-,Line ---------------------- SEEPAGE PIT Depth Diameter, �Q- Number ---o7----------------- Rock Filled Yes No 0 1 10 ,,- Water Table Depth --------9 --------------------------------Rock Size ------------------ Distance to nearest: Well ---z'fO- -4V--4 ------Foundation' Prop Line ---:-4--------------- REPAIR/ADDITION(Prev. Sanitation Permit ------------------- Date ---------- -------------- -------- "Z9---------- Septic Tank (Specify Requirements) ------------- ----------rte r-------- , Disposal Field (Specify Requirements) ---------- ---------- ------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- f ------------------------------------------- i------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------I------------------0--------- (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 Son Joaquin Local Health District. -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 manneir as to become subject to Workman's Compensation laws of California." Signed --- ------------------------------- ---------------------------------------------------- Owner ---------------------- Title -- ------- ---- --- - -------------- ------- ---- By ------ - --- ---- 554 (if other than owner) 1,n FOR DEPARTMENT US ONLY V4----------- ------------- APPLICATION ACCEPTED BY --- ------ ------- DATE -- ------------------- BUILDING PERMIT ISSUED - --- ----------------------------------------------------- --------------------------------------DATE -------—------- ----------------------- ADDITIONALCOMMENTS ------------------------------------------------ ---------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- --- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------- - -------- --------------------------------- -------------------------------------------------- -- - --------------------------------------------5-5; - ------ FinalInspection by:,---- --------------------------I------ --------------------------------------------- ----------------------Date---------------------------------- --------- HEALTH..D I STR I CT, - SAN-`JOAQUIN LOCAL- E. H.,9 1-'68 Rev. 5M