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APPLICATION FOR SANITATION PERMIT Permit No. ..7f` .....--..... (Complete in Triplicate) "' ................................I.................... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the Son Joaquin local Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordin)pnce No. 599 and existing Rules and Regulations: //E o X JOB ADDRESS/LOCATIONL.5l1y.` 4a. /!"/ +s .0�? ` }�/z... ..r -....,CENSUS TRACT ........._............... — Owner's Name � � �"-•-•-�..... ..Phone . J / Address . . �7 City . . . ............................ Contractor's Name ..... !-. .. .... Jam .... ......:.........License # .�� t. ..... Phone ........................... Installation will serve: Residence ❑Apartment H!?.!AmCommercial❑Troller Court ❑ /7 Motel E]Other ..� ../ s�i� T So rmv, Number of living units:............ Number of bedrooms -...........Garbage Grinder ........._ Lot Size ............................................ Water Supply: Public System and name .................................. . ...--------------------._.---------.-.-.-.-........................Private Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam � Clay Loam ❑ Hardpan❑ Adobe L] 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 I ] SEPTIC TANK[ ] Size................................................ Liquid Depth .......................... Capacity -------------------. Type .................... Material------................ No. Compartments ..................... Distance to nearest: Well ......--.•..........................Foundation ......-............... Prop. Line ...................... LEACHING LINE [ I No. of Lines .._------- ------ ..... Length of each line---------- ................. Total Length ............................ 'D' Box ............ Type Filter Material ............--------Depth Filter Material ................ Distance to nearest: Well ........................ Foundation .................. Property Line ...-...-.....---.-..--..... -SEEPAGE-PIT--[-I -- Depth-. diameter ..........:..... wffibe�r ....................... Rock Filled Yes ❑ No 0`1 ' Water Table Depth -- - -- -- ---•............................Rock Size ................................ 1 Distance to nearest: Well ........................................Foundation .................... Prop. Line ........._........... REPAIR/ADDITION(Prev. Sanitation Permit# ........... ......-...................... Date ---...............................I Septic Tank (Specify Requirements)_ .:_ ............ pos I Field (Specify Requirements) © �n - Y -----A----- . .. . _due--- _ ._-•-- ,, < a. -----_.--._ ':::::::::::::::::::::::::::::::::::::::::::: a ..-- (Draw existing and required addition on reverse side) 1 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: "1 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 .... ---• - -- _. �, rf�. Title . t _11L ..................i: .....__......_ _....-. ....._ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... ...... . DATE .._ .`.2--- -.- ----.-------- BUILDING PERMIT ISSUED ----.....- ---... -------- -------- ......... ..............................................DATE ........:.. ............................. ADDITIONALCOMMENTS -------------------_-------------------•-- •--- ....----- - - -- .._.....--•-....-...... - ------------------------------ ...... ----------- --------••-............................. - - --------- -•---------------............... . — --------------------------------- ---------- - ._... - - - --------------------------------- - - Final Inspection by: ------------------- �-- ---- --- '� ----- --• -- - ---- --- - - - -...................Date ...Z EH 13 24 1-68 Rev. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M