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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 s. 6 ji ...................•......................I.....-•--.• Permit No. 1Complete In Triplicate} 7.................. This Permit-Ex €res 1 Year Froin Date ......................................................... _ '' Date Issued ---�r•/a-7 p slued . Application ' e the-Son-Joaquin Local Health District for a permit to construct and Install tate work herein describe T i Ii tion 's otle';ih-�6M Mance with Count. Ordinance No. 549 and existing Rules and Regulations: �q p P y JOB ADD ... Owner's Name ...-.... - -_ .................. ....E......-- ............:...:.. ............................... ... oneY7X-.2.74 ' -- .._.. . ,.. Address ...................... �%��.r' "" .#� ._........:City :........ ._.._._._. Contractor's Name .. .... ............................................. _._.... „ ..... '..License #2R-,JB --- Phone gi_-=� -01----------- Installation will serve: Resider`tce Apartment House �Comniercial OTrailer Court �] Motel j]Other._._.f.. •-••--••- ------------ Number of livingy units:___... _._.. !Number of bedrooms �_._`:�arba_ge Grinder ............ Lot Size _.�._.:�c�s Water Supply: Public System anti name r private................................P iv tem] Character of lost to a depth of 3feet: Sand n S€lt:f,)L,Clay-f�Q I feat❑ Sandy Loam o Clay Loam ❑ Hardpan[] Adobe ZFill Material .. ..... If yes,type ............... ......•..... (Plot plan, showing size of lot! location of system in relation.'to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: f ;I .d � ' INo septic tank of seepage pit permitted if public sewer €s available within 2QQ feet,) PACKAGE TREATMENT f ] SEPTIC TA14K�j ize_..........�?-.-r��'................... Liquid Depth ....... ........� Capacity 1 ......__`LType O ----- al...0 -G--- No. Compartments -•--------� . . I r Distance. to nearest: Well, == ---------ater. .Found tion ----1'Q............ Prop. Line __ .....:....... LEACHING LINE No. of Lines ......•----------------r Length of Ra line..-- - _ 11:. Total Length .,. ............. - D' Box F.....t hype ilter�Ma#etial" .............. ..Depth Filter Material ..._1. ................................ .�- I Distance to nearest: Well _.-_ _ ............ Foundation. ..... ...... Property Line :�................ SEEPAGE PIT Depth '.__I{�f..__-• Diameter ._X _:, "Number ............ — _--_ Rock Filled Yes ,� No Q ~`t Water Table bepth -------- --------------------•...... ...........--•.......Rock Size -'W.fx---`xL�... Distance to nearest: Well �v 4 ...Foundation ....tV._.r ..... Prop. Line ... .............. REPAIR/ADDITION(Prev. Sanitation Permit ` ._. ........................-....... Date a---------- ...I.._.........._..) Septic Tank (Specify Requirements) .........----------- ....................... __--• ..............:.......................-................... Disposal Field (Specify Requirements) --- , .. .... -_. ------••••--....-•-•-------.•------------------ ....................................... --------- ----------------••-•---•- --•--•---- .................... •• --------••--••--•-........_.......--•-•-•-----------•----........ -------------------.- ----------------•---- t t (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 San Joaquin County Ordinances, State Laws, and Rules and Regulations of thejSan Joaquin Local Health:District. Home owner or licen- sed agents signature certifies the following: j t "I certify that In the performance of the work for"which this perms#,is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." ' Signed -- 3 ------- - .. ...--------•-.-- Owner By ....-. - f -------------- ----------- Title - -- _...... ( of r han owner) -- •. ...... ........ ..•-_. . R DEPA TMENT USE ONLY APPLICATION ACCEP ED BY --- ---- -- BUILDING PERMIT ISSUED ADDITIONAL COMME.NTS ---------------- ---- ----------• --• - ' '.�1 .......... ------•--•--;------------------ 4 + -- Final Inspection by: ._.__" :. .. `. ..: = ----------------------------- • -- Date .. - -•- -7J...__....._.. EH �3 2h 1-68 Rov• 5m 5Ai*f JOAQUIN L AL HEALTH DISTRICT 8/7h 3M