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r,wK Urrnx Vbr: AppLICATION FOR SANITATION PERMIT .. Permit No. .. �f 1Cor�uplete tat Triplicate) :"�. �`:. Thla isr+rrealt Eaires 1 Ysar From®oto Issuedate issued ... Health District for permit to a:onstruct a oric herein t the Son Joaquin Loc:s! Haa h P �ppiltatlora la hereby mads a> � .ascribed. This application is made in eompii nce with Co my Ordinance No. 549 nd xistin Ruts a ul Ilona 1, a CENSUS TRACT .......................... JOB ADDRESS/LOCATION 2 !? Owner's Name .. . ----------- - j ......Phone .................................... Address .... ....., �. L(!�._ '�-fi`.1 C _ ._..Cih► ................................................. . .. Contractor's Name . _�. .<... License � ��.: -XPhan® Installation will serve: R sl ence❑Apartment Haus .Q Commercial❑Trailer Court 0 Motel ❑Other/ � Number of living units------------- !dumber of bedrooms ............Garbage Grinder --- -------- Loo Size --------------------- ....................... Woter Supply: Public System and name ---------------------------------»--'-................--................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ SIlt❑ Clay ❑ Peat❑ Sandy Logen o Clay Loom ❑ 4- HardpHardpan an❑ Adobe nFill Material . ..........if yes,type.....-•--•..... ........•.•• v (Piot plan, showing size of lot, location of system In relation to welts, 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,! Size............ ........_.I---............_.__.... Liquid Depth ..................----• -� PACKAGE TREATMENT [ l SEPTIC TANK j Capacity I 4!p4kAype ..�yi Material...................... No. Compartments ..��...---....--- Distance to nearest: Well _... ...............Foundation ...................... Prop. Eine :..................... LEACHING LINE g j No. of Lines -------------- length of each fine-74............... .._. Total Length ' ........... .Depth Filter Material .... . 'i�' Box .�....... Type Filter Material .. ................................. Well ........_•............. Foundation .....------............. Property Line -----..._............. Distance to nearest: Vice - ' SEEPAGE PIT [ g Depth .................... Diameter ................ Number ............................ Rock-Filled Yes 0 No Q. WaterTable Depth ----- -------------- ...........................Rock Site ................................ Distance to nearest: Well ........................................Faundatlan .................... limp. Elns -----------•-_y._.... REPAIR/ADDITION(Prey. Sonitallon Permit# -------------------------------------------- Date .......................----------- Septic Tank (Specify Requirements) _•...................................... ........._.............-----................................_.......... ................ Disposal Field (Specify Requirements) ............................_........................---------........................................,............................... -•----------• ••...................•------....---...-------------------- ---------...................._...................•........................,..................................... .._.. (Draw existing and required addition an reverse side) I hereby certify that i have prepared this application and that the work veil! be Slone in aacaonkmee. with Sou Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District.Hama owner Or Itcen- 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 fserson in such manner as to become sub ect to Workman's Compensation latus of California." Signed r ------------ Owner • ---_. litle ---------------------------------------------------------------- ------ ! (If other than owner( FOR DEPARTMENY USE ONLY � APPLICATION ACCEPTED BY -------•, .................---_... DATE :..47.0:/ :...:.. = f---BUILDING PERMIT ISSUED ........ ¢ ADDITIONAL COMMENTS .... .......... ............................................................... .._......._........... ..... _..........,. - ._. ... ---•.... .. ......... . ............ ------------------------------------------ .........................-........ ................ •-............_...__._ ...... ...... •..- ...... ................... Date f - . ` Final !ns ed�on b EH 13 2h 1--68 flava !�4 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h .3M