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rVK urillu mt! ............ 0 APPLICATION FOR SANITATION p .....................__........ ERMIT .......... .................. ..........I........._ • (Complete in Tripucatel Permit, No: This Permit Expin" Date issued .,/ ' Od ....... I Y6�tr From Date Issu 77 Application is hereby mode 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';'Ordi nonce No. 549 and existing Rules and Regulationst 'JOB ADDRESS/LOCI&N �,4 W J. • S C. . amtwu, TRACT .................. ........ . Owner's Name .....tn P, ........................ .................................... Address ltom... .... ------*----------- - Ity, one ........ Residence[]Apartment House C Contractor's Nomi 14 ......... ......._............... Installation will serve. .........License Ph ane J*nailer Court 0 0 Motel 0 other 110".4v. Number of living units:_,Vk. Number of bedrooms A%._-Gcrboge',Gr1nder Lot Size Water Supply: Public System and name ........ .00 0410- .....................I............... ...... I /I Character of soil to a depth of 3 %-A ...... ....... ................_...-Private 1�et.. Sand, Silt 0 Clay'< P"11 SO"*Wam 0 Clay Loam 0 Hardpan 0 Adobe 0 Fill M6ter'jal ...... If yes,type............... ........... Mot plan, showing size of lot, location Of system In relation towells, buildings,,etc. must be placed oTreverse side.} NEW INSTALLATION: (No Septic tank or r seepage pit permitticl If public sewer is bvailable within 200 feet.) PACKAGE TREATMENT I ] SEPTIC TANK 'Size,.......... ......... .......... Liquid Depth Capacity ........___ Type ...... No. Compartmetits ....... Distance to nearest.. Well ............ 4' , .......Fotrndatio'n ............... Prop.Line..-:._..1r....... LEACHING LINE No. of Lines Length of each line.... ........ ......- Total Length _f7........ ............ • V,BOX ............ Type Filter Material .................Depth otter Material• ..... AI Distance to-nearest. Well ............ .... .... Foundation. ..... Property Line ..................... SEEPAGE PIT Depth Diameter ............... Number .-I I t % - ---------- ........ Rock Filled Yes [I-"'No Water Table Depth ...... I .................... ------------_-_Rock Size ... I.................. ........ Distance to nearest. Well _.:................4._. 1 ------- .......Foundation .................... Prop.' Line ................... REPAIR/ADDITION IPY*v. Sanitation Permit#............. ---- 4 - -- -- .......... Date .....7— Septic Tank (Specify Requirements) :7... .. Disposal Field (Specify Requirements) .... . ........... ...................... ........ ......... ................ ........... ...... ....... .. *I! � . " , I I ...........- !Draw existing' .....and required addition on'rev&s:e side) I ........ C1 hereby ce"ify that I have prepared this application and that the W_WV'WItI' be done in accordance with Son Joaquin ounty Ordinances, State Laws, and Rules and Regulations of sed agents signature certifies the following: the ion Joaquin Local Health District. Homo owner,or licen- "I certify that in the Performance of the work for which this Permit is Issued, I.shall not employ y person In.such Manner an become to becae suble t to Workman's ComPqnsaftn laws of Califorrila. Signed .... ....... ..I,_ ---- Owner By --- ------- .......... ......................... (If other.thon owner) .......... Iftle.... ........ ....... FOR DEPARTMENT USE dWy APPLICATION ACCEPTED BUILDING PERMIT ISSUED .......... DATE—;_ DAT ... ....... T. ....... ..... .............. ......... 'TIONAL COMMENTS ------------ �ADD z4s.... ...... tow, X> Final Inspection by-_-.1X:7 ... ... ...... ----- --- Date a 13 2h SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M