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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..._..................................................... (Complete in Triplicate) Permit No. 60..9..-.. r,. ._.. ............................ This Permit Expires i Year From Date Issued _ Date Issued Application fs hereby made to the Son Joaquin Local Health District for a permit to construct and install the wotk herein described. This application is made in compliance with County Ordinance No. $49 and existing Rules and Reguldflons! t I JOB ADDRESS/LOCATION .1-2J.' w:.....IL—V'r -_a - •--•.•.----- ........:...............CENSUS TRA -/I Owner's Name Phone .. .. ..,. Address .. .•7-- (!S! : - . - ... City �/� -- .... ...............=' / -P Contractor's Name .. - ..---'------ .G./."'__...._'. .-.--".--_------`............:.........License tlt Ta.!J.IS._. Phone 0010!4 -- Installation will serve: Residence Jg Apartment House Commercial[]Troller Court 'C7 1 n Motel ❑Other, - ..,,............._............ t Number of living units:............ Number of bedrooms --------.__Garbcge.Grinder ........_._ Lot Size ------ ---.------------ ...... -_-_-_------ t Water Supply: Public System and name . - -•-•................................ --'---------------------------------------------....--"-----Private ❑ Character of soil too depth of 3 feet: Sand;d Silt❑ , Clay..O Peat o Sandy Loom o Clay Loam.i] Hardpan Adobe flFill Material ............ If yes, type ..... '--- (Plot 4.". plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK T ] Size ............................................ . Liquid Depth ...................,..... Capacity . ._..... ... ..... Type --------- ----.. Material...................... No. Compartments --- Distance to nearest: Well ....................................Foundation ...................... Prop. Line ........;.....,._._. LEACHING LINE [ j No. of Lines /..*:.......... Length of each line----fio..v._.._......... Total Length ......1.at..._.._._ R 'D' Box ------ Type Filter Material Depth Filter Material _.....1.f..................�,.,.._...._ y Distance to nearest: Well .....67T.............. Foundation ........ ........ Property Line. ..... .......... SEEPAGE PIT Depth Diameter Number ............................ Rock Filled Yes ❑ No Water Table Depth ..............................••............._.Rock Size �_._.._...... I Distance to'nearest: Wel[ ........................................Foundation ----- .............. Prop. Line ......... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I ` Septic Tank (Specify Requirements) ......................_ __......-...:....-------.....---- ....____ `.... y�_.....i.....------ wd.Disposal Field (Specify Requirements) ---iCY _.._....&5.�__.._. ..-.: ec-�...__ Nt_ [._lZ......ya....._..... G^ 1..-5-/./!✓�f_.._sT ..t3�sYl..... ..........................-..............--...................... ............................ ............ ....-.... (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 Joaquln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner r licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner as to become subject to Work n's Compensation laws of California." Signed .. . -- -. . .. . ......----.—_--t- - ----- Owner V By ..__.. -. ._.�.._.....t.... . ...--"- --.... ..........................._ Title .............�_,.. i (if otherhan owner gp• . FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY.lc/ ..... -......................... ..........................._... DATE ---� ��L�l....-�.......... BUILDINGPERMIT ISSUED ...............'.......... ..........MM........................-----------'----------- ------------..DATE .......Z-......en.............L..... ADDITIONAL COMMENTS ----......-- --'----t........_.......---•-----_....--'--....................... _..... ..................... . ...................._..---.._......_....__..._...............-_......---••---._.......----......---................----._........I------.._..:.--- . ..........................._-........_.. -. _. _. _......... - FinalIns ................................. ........... .. .............._.....___... _ pedionby: ..-- -- .:._ ,.,--- • -- - --- -------"..-----------•------........--------:......------.:...._._..._..Date __._1.2. ._�0 - E. SAN J IN LOCAL HEALTH DISTRICT H. 9 1-'68 Rev. 5M.