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APPLICATION FOR SANITATION PERMIT Permit No. 2K-..411,?% CompletolnTriplIcaft) 4 This Permit Expires I Year From Data Issued Date Issued f.:.. Application Is hereby made to the Son Joaquin Local Health District for a permit to constnkt and Install the work herein 4 described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESS/LOCATION VAe.CENSUS TRACT .......................... Owner's Name I............................. Address1 City Contractor's Name ,. t Llcens."g." Zl"...... 2--.. Ph a n a Installation will serve: Residence WApartment House C] Commercial OTraller Court r Motel []Other............................................ Number of living unit::............ Number of bedrooms ../A.....Gorbage Grinder -......... Lot Size ............................................ Water Supply: Public System and name .....------•---------•-••--........_......................................................................private Eq- Character of soil to a depth of 3 feet; Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loom (] Clay Loam E3 Hardpan C] Adobe 0 Fill Material ............If yes,type ............... ............ Mot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse slcle.NNEWINSTALLATION: (No septic tank or seepage pit permitted If public sewer Ispvalloble within 200 feet,) i4 PACKAGE TREATMENT SEPTIC TANK f 4. ........ Liquid Depth ......................... Capacity Je P P-4d.Aype ... No. Compartments __........... Distance to nearest.• Well ....IAO............. ...Foundation Z,4!----_--_-.. Prop. Line .................... LEACHING LINE No. of Lines Length of each line..747................... Total Length ......a............ V Box ....... Type Filter Material Depth Filter Material Distance to nearest: Well ........................ Foundation ........................ Property Line ........................Z%Nli SEEPAGE PIT Depth .................... Diameter ................ Number ............................ Rock Filled Yes E3 No Water Table Depth ................................................Rock Size ....................... ........ Distance to nearesti Well ........................................Foundation .................... Prop. Line .................•--• REPAIR/ADDITIONIProv. Sanitation Permit# ....................................... Date ..................................I SepticTank {Specify Requirements) .......................... .................................................................................................I.......... DisposalField (Specify Requirements) ...................................................................................................................................... I.......................................................................... .................... Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be dont In accordance with Son Joaquin County Ordinances, State Laws, and Rules.and Regulations of the Son Joaquin'Local Health District. Hem* ownw or liven. sed agents signature certifies the following: I certify that In the performance of the work for which this permit is Issued, 1'shall not employ any person In such manner as to become subject to Work an's Compensation laws of California."D,' Wo, Signed Owner By .................................................................._.................................. Title .11-1........ ....... .................................. ............. if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY rme........... ......................................................... ..........,DATE BUILDING PERMIT ISSUED .., ,ATE ................ ADDITIONAL COMMENTS I.......................................... ................................. ............................................................................................................. 1...................................................................... .................... I............................ ....................... .............................. 52 9.........................I........I............I............I— - -.............I..... .................... FinalInspection by: ........ ................I...................-......................................... .........................Date EH 13 24 1-68 &v.SAN JOAOUIN LOCAL HEALTH DISTRICT 8/711 3M