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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7.1....`!.x•° \ I (Complete In Triplicate) Date Issued . .. .... .. This Permit Expires 1 Year From 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 Ordinance No. 549 and existing Rules and Regulations- 0___ __ .. WAR S F N CENSUS TRACT .. .�.. --•-- JOB ADDRESSAOCATION 2163 5 Owner's Name HENRIX. . H,0FF......................................... ........ .. Address ' City . .._... .. . Phone ..........................._..__.... X2,357://. . S WAR.R EN... ........... City R I.PO r` ....... ........................._. Contractor's Name LAJ,N.FK ...License # .. _ . Phone ............................. Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ... 2 Number of living units: Number of bedrooms . 1......Garbage Grindeyr—S Lot Size ....A.C.R47=AC%E-- y Water Supply: Public System and name ................. ...............................Private ,eu•'/ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Cloy Loam ❑ 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 sei page pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I I SEPTIC TANK( Size........................ Liquid Depth .... .................. \ ' Capacity Type .. _ . ... ... .. Material.. ... No. Compartments ...............«.... r *� Distance to nearest: Well . .......... .......Foundotic .... .......... Prop. line................. +' LEACHING LINE [ J No. of lines length of each line Total Length W 'D' Box Typ Filter Material .. .................Depth Fi er Material . . . ..................................... Distance to nearest: ell e... .. . ............. Foundation Property line , SEEPAGE PIT ( J Depth Diameter ................ Numbe• . Rock Filled Yes ❑ No G M. �,. Water Table Depth .................................Rock Size ............... �. .- Distance to nearest:. Il ..... ......._...I.....................Foundat .................... Prop. line ..................... REPAIR/ADDITION(Prov. Sanitation Permit#�.... . ............................... Date ...... .........................) Septic Tank (Specify Requirements) . . ... .....................p......................................................... . .......................... ... Disposal Field (Specify Requirements) ....../.�.�•Fl� •• ... - N .................. /D0 ' + 60 ' �ACr4 1- NImo,, ....T........... F-�rT".. . X� Tt.N..C-...... .50PT«.. '!51V,-- T� .... ................. ............ ... ............................................................................ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with Son Jeogtsin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or IIaM sed agents�lgjnature certifies the following: "I certify t a in the perform c of the work for which this permit is Issued, 1 shall not employ any person In seek ntatr+er as to bec subject tom Wor n's pensation laws of California."Owner ^ Signed .�� ... ..... ........... � i By � `f'R,a� .......... Title . ...... .. _..... ....... .................... ;. (If other than owner) FOR DEPARTMENT USE ONLY .. . APPLICATION ACCEPTED BY Tr R- � ......................... .... .. ... .. .._. . ....... DATE . ..'/-* ATE . .. .-. . . .... . ................. BUILDING PERMIT ISSUED ......... ....... .. ........ ......................... DATE ,.. ADDITIONAL COMMENTS r. �:Vii. ......,. .. . ....... ..............................................................::..... ......._ .............................................................. ««...... f �, . .. ...... . ...... .. J .. .... . Date ...1. . :.....Final Inspection by � C' SAN JO, ' IIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M