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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT X lComplete in Triplicate) Permit No;-7 ............................ ....... ............. .... This Permit Expires I Year From Date Issued Date Issued AppEccition 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 Ordinance No, $49 and existing Rules and Regulations, ;OB ADDRESS/LOCATIONFp *..........*................. .... - ------------E---.-!,-o-- ----------Dlano....... CENSUS TRACT ............. 1 1. , Owner's Name ............................-.................. ........... Phone Address9a Ip ........ ....... ...... .........................-----, City -S-tk-n............ ........ Contractor's Name .-S!qP�1.9.14Ak........................License # Phone -461-70a...... L Installation will serve: Residence 7-1 Apartment House 0 Commercial -)TrailerCourt C] Motel D Other Number of living,uhits....1 Number of bedrooms Grinder ............ Lot Size _...5.- .......... Water SvPPIY� Public System ond.'name ........................... private % Character of soil too depth of 3 feet,` 4Sondo Siltin Clayl-IPeat Sandy Loam Ll Cloy Loam [-1 4 Hordp6n r Adobe El 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 4 : (No septic tank or seepage pit,permitted if public sewer is available within 200 feet) PACKAGE TREATMENTJ SEPTIC TANK J] Size... ................... Liquid Depth ....... ...... ..... . . Capacity ...... Type ... AC.1c........ No. Compartments Distance to nearest. Well . ..i 20.01 ..........Foundation .. 3Q!...-..,.. Prop. Line.........10,0.!.... LEACHING LINE I NA k] No. of Lines ................ Length of each line..1-00.!.............. Total Length ...10GA............ Box Filter Material -2".-.---Depth Filter Material ........ Distance to'neorest: Well Foundation ..x.0.0-*.........-.. Property Line 100J.............. SEEPAGE PIT 5d Depth 15�0- — :-3601 1 Diameter ... Number .... Rock Filled Yes M No C Water Table Depth 90 ..................Rock Size .... ...... Distance to nearest: Well t*rn!=*.............. - Foundation .......-1W.11 Prop. Line ...... REPAIR/ADDITION(Prev. Sanitation Permit Date ....... .................. Septic Tank (Specify Requirements) ............. ................. Disposal Field (Specify Requirements) _._._»..,.,..,,.------.»------------------------ ........... ......—................. (Draw existing and required-addition"o'n"reverse'side) , ,J hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or (icon- 4 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 wW person in such m.ann4w as to become subject to Workman's Componsatian saws ,of California.- Signed .................. ............__..... ........._. Owner. By ....... .... Title (if other than owner) FOR DEPARTMENT USE ONLY APPLICAPON ACCEPTED BY*. .......... ............... DATE BUILDING.PERMIT ISSUED ......... ADDITIONAL COMMENTS............ . ............. ........... .............. ..........I............._.. ....... ....................... ........ rinol Inspection by 77------:: .' .: --k . ......... .......... ............... ........ /A SAN JOAQUIN LOC L HEALTH DISTRICT 2� E.H. 9 1-'68 Rev. SM