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FOR OFFICE USE: �,OipPLICATION FOR SANITATION PELT -- - (Compiete in Triplicate) Permit No. _ ---_--------------- This Permit Expires 1 Year From Date Issued Date Issued _.....___...:__.L Application is hereby made to the S Joaquin Local Health District for a permit to construct and install the work herein described. This applicatio 1 compliance with County Ordinance No. 549 and existing Rules and Regulations: 5y -- JOB ADDRESS/LOCATIONl_ -- --- - -_C ------ -- --.. -- ENSUS TRACT --- ----------- Owner's Name _! p ;�— �-��f'�----------- --- -------------- - - Phone-76 ne�.-1-3451/0- - Address ? 43-bx- t--------------------- ---------------- ---------- ----------- City _C_K1C M* W}S - cion-11V--- ----------------- -- _Contractor's Name -M-a- y_r__R------64t_Ptt'a--TA-W-k-SORicense # -40-+ A`uPhone 14-2.--.L.4R. Installation will serve: Residence ['Apartment House Commercial ❑Trailer Court ❑ Motel ❑Other ------- ------------------------------------ Number of living units:----I------ Number of bedrooms __ . Garbage Grinder ---O ----. Lot Size r Water Supply: Public System and name ----------------_ --- ---------_---------------------—-------------------------------------------------Private O _ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay R Peat C] Sandy Loam 0 Cloy Loam C] C Hardpan ❑ Adobe ❑ Fill 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` PACKAGE TREATMENT [ ] SEPTIC TANK i ] Siz _�.(_.� ,y._. kid---_--------r---- Liquid Depth ------ Capacity ------C + No. Compartments ------------ Distance to nearest: Well ._S__g_f ---------- ._......Foundation -------------------- Prop. Line ---------------------- LEACHING ____________________LEACHING LINE [ ] No. of Lines -A---------------- Length of each line.......ff*Q------ ------ Total Length .......... 'D' Box ----4._._ Type Filter Material ___amiliepth Filter Material -----------(_.V--------__---------.------- 0\ Distance to nearest: Well ....3---T O___- Foundation ------------------------ Property Line SEEPAGE PIT [ ] Depth 2S--- ---------- Diameter -3--3--___ Number -----------3---- -------- Rock Filled Yes ®.. No Water Table Depth ------------------.---------------------------Rock Size . _ _4----------------- Distance _ -------- Distance to nearest: Well _.___.3. _O._ _____ _ ._-_._-Foundation ._.. .............. Prop. Line ........---.--..._... REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- Date _____._-_...._.._-_.._.._.__--1 L Septic Tank (Specify Requirements) -----------�--�rr --Q--CS----. r�_-.--.-----......--j----- - -n-------------------------- -�_----- - - Disposal Field (Specify Requirements .._-�_,a_Q_.._ ._. __ __.(�t� .!G�G.G t�kal-„/-GSR.+^- ____-_.�$,.«s ..._.__--____ r ! -- -. -�' ^oar, (Draw existing and required addition on reverse side) ` I hereby certify that 1 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 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 manner as to become subject to Workman's Compensation laws of California." Signed ------- -- - -- ---- -------------- ------------------------------------._ Owner .� By -- ------- --- --- -- --- ------------- Title �r�► ,e,------------------ - ------- --------... (If other than o r) FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY -- ~- - - - --- - -- . DATE °��/ ____---------- -- BUILDINGPERMIT ISSUED --------------------- -------- -- ---- ----- ---- - ----------------------- ----- --- -DATE - - --------- --------------------- - ADDITIONALCOMMENTS ---------- --- --- ---------------------------------_--_---------------------------------- --------- --------------------------- - - - -----------—-- --- ------= --------------------------------------------------- - --------------------- --------- -----"---------------------- --- ----- ---------- - - _ �f - - --- - - - - - - - -- -- Final Inspection by: . - - �!- -------- -------------- -------------- ------- ------------- Dater - - - - - -- - - - - -- --------------- ------------- --- -- - --- ------ -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 l-'66 Rev. 5M