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FOR OFFICE USE:.. ..... APPLICATION............ N FOR SANITATION PERMIT ........... (Complete,In Triplicate) Permit No. —------- -----.............__........ This Permit Expires 1 Year From Date issued Date Issued Application is hereby made to the Son i IcI described This a Plicatil oaquin Local Health District for - permit to construct and installthe work herein �f^/ S" on is made in compliance wit ounty Ordinance No. 549 and existing Rules and Regulations: JOB TION Owner's Namei. CENSUS TRACT 2-!20-V3 ........................ ........ ......... Address I ............... -.-Phone . ................... Contractor's Name ..... City ..... .. .......... Installation will serve: Residence partm .......... ..........License # Phone ent House.0 Commercial{]Trailer Court Motel E]Other.-of living unItsI.__1_. Number of bedrooms ....Garbage Grinde Lot Size ... 7 Water Supply: Public System and name ................ Character0f soil too depth of 3 feet: Saryc[E] Silt[]......Clay-Y -----PeatI -C .-----------------------Sandy Loam.0....................Private Hardpan 0 Aclobev,Fift I M.aterial -.4-ol Clay L.;�� yes, type ............................ (Plot Plan, showing size of lot, location of system in relation to:wells, buildings, etc. must be Placed on reverse side.) NEWINSTALLATION (No septic tank or seepage pit permitted if Public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK 5/Size --------- f ly 19X Liquid Depth Capac! --- Ty p e P/1 . .. .... ...... ��Z.......... Compartments 4R Distance to nearest: well ....._��/ LEACHING Ll - --------- .....Foundation ...... NE No. of LinesProp. Line X..� V Box -_.-.-;Z.__-------- Length of each line_.&.,,L...E�..... Total Length ............. • V,J -ye-2-- Type Filter Material Depth Filter Material ................... Distance to nearest: Well ----------- Foundation ...14�.............. Property Line ..._457_ ........... SEEPAGE PIT Depth QS� -------- Diameter --- Number ......... Water Table Depth .......6 ........' Rock Filled YestEt--No 0 -------------------------------Rock Size... 3 Distance to nearest: Well ....... P-V t REPAI VADDITION(Prev. Sanitation Pe /-�............... -•_-Foundation A.!......... Prop. Line ........ Septic Tan_k Permit#--------- ----------- �___Date ............ . ...... .... ep (Specify Requirements) .................... ...... Disposal Field (Specify Requirements) ..................... .......... ......;..................................... .......................................... rn............. .................................... ........... .................. .......... ................ ........................I....................... .......... .___ -_ -, ,.. � I ......................................... ............................. -- ------------------- -(6raw existing and required-- - -- ------------ - ....... ............ .................._........................ I hereby' certify that I have Prepared this application and addition on reverse side) that the work will he 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 eniPI*y any person in such as to become subject to Workman's compensation laws of California." monnei Signed By ......... ---- .......------ Owner ............ -CA-)- ----------------- (if oth r t an owner) �.........?�........... Pile --------- APPLICATION ACCEPTED s-y-`_ FOR DEPARTMENT USE ONLY BUILDING PERMIT ISSUED ...... ---- ------- ----- .................... ---------- ------------ DATE '77 ---- --- ADDITIONAL C - .................................. ..-----------DATE -- - - - --- - -------........... L q _CA ....I.... . ------ _................... VXB!trit...b L ....I...............I............... ............1............... ......... ...__...... ................ 24V %3��-- -----------------------..... ---------................. ----------------------------------------------------------- ............... -- -------- -------------------------_-__---------- ............................... ---_---------_........ ........ ............. ----------_........ ... .............. -------- ........................ al Inspection by: .... .............. .............I........... ...... -------__..........Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M