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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .................................................. (Complete in Triplicate) Permit N.,.:7 Dote Issued ...... ............ This Permit Expires I Year from Data 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 mode in compliance with County Ordirtome No, 549 and existing Rules and Regulations: JOADORM/LOCATION ........ ...... -CENSUS TRACT .......................... B Owner's Nome ie2� . ........ . . .. . ........... ... . ............ ... i�" Address.............. 4--.— city... ......... 1-1 .................. Contractor's Nome .... if 149ki ...... License Phone .............................. Installation will serve: Residence C!!rAportrrie rt House 12 Commercial OTrailer Court C1 Motel E] Other ......................................>,...., Number of living unitst ... Number of bedrooms -?..Gorbage Grinder . ........ Lot Size ..............................»,....... . Water Supply. Public System and name ................... . ....... . ...... . ....... . ....... -- .. . ...........................Private Character of soil to a depth of 3 feet. Sand 0 Silt C] Cl y M Peat 0 Sandy Loom 0 Clay Loom 0 Hardpan 0 Adobe IZfill Material If yes, type .................... --- ji'lot 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 Ifpublic sewer is ovaiia6te within 200 feet„!PACKAGE TREATMENT SEPTIC TANK f I ... Liquid Depth -Y ......... . ....... Capacity -Type& No. Compartments .- Z . .......... 'Distance to neorestt Well ---jL4 ................... Foundation ....... Prop. Line ..... I A ... . .......... .0 LEACHING LINE jNo.of Lines ... _J ............ ... Length of each line ......... 3A�tP".- Total Length ... V BOX Type Filter Material Depth Filter Material .... . . . ............ Distance to nearest: Well .... ........... Foundation .... ...... - Property Line ... ...... Depth "0.. w"remig, Number ........ Rock filled Yes &0, NO Water Table Depth ......... -4.0- ...........................Rack Size ....... 14 Distance to nearest: Well . . . ......... /,-P..4?,.4A�--..Foundotion .... /A . Prop. Line REPAIR/ADDITION lPrev. Sanitation Permit# ............... Dote Septic Tank (Specify Requirements) ....... ....................................... ........ . ...... Disposal Field (Specify Requirements) ... ... . ...... ... � 4- .. ....... .......... ....... ......... --- .......................... ............ — ................... . ..................,draw ......... --- ....... . ... -- ............. ..... --- ........ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be don* in atewdeftit with Son 36"U11% County Ordinancos, State laws, and Rules and Regulations of the Sao Joaquin Local Health District. M*m* Ow"Or Or lie** sod agents signature certifies the following: "I certify ihat in the performance of the work fair which this permit is Issued, I *hall not ompl*y any person in surk mannOr as to become subject to Workman's Compensation laws of California." Signed-.,- ...... Owner By litle ........... .... ...... (if other than 'owner) APPLICATION ACCEPTED BY .... ................. ........ ---- .......... --- .......... � DATE ........ BUILDING PERMIT ISSUED ............ ......................... ---- ...... .... I ................... .DATE.......... -- ............ ......... ADDITIONALCOMMENTS .... ........... ............... ............ .............. ...................... ................................ ............ I ........... I ............... .......... ............. --- ................. 'Fin -a- I*drispection tltera . .............. — ...........................,......,...............Dote ......... . ....... SAN JOAQUIN LOCAL HEALTH DISTRICT E, H. 1-3 241-,68 Rev. SM 7/72 3 M