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FOR OFFICE USE: ..... I, APPLIC&ION IFOR SANITATION PERMIT ..............»,...,......_.._..,,._..__-.... Permit No. __73— lComplets in Triplicate) --- . . ..... . ..... ................ .......... ...... This Permit Expires I Your From Date Issued Date Issued 0 Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work heroin described. This application gas made in compliance with County Ordinance No, 549 and existing Rules and Regulations.. JOB ADDRESS/LOCATION [JV4, '4* _ CENSUS T4ACT Owner's Name k", Z1 .... . . .... ..................................... Address .... ........ ......... _ ...... _ City i,; Contractor's Name . ......... ............ ............ ........ # Mono Installation will serve.�7Re sicle�nce �Portment Housed Commercial OTrailer Court .0 Motel [:] Other. ....... Number of living unitsi..... ... Number of bedrooms ....,,,,...,Garbage Grinder .. ........ Lot Size ....... ...... Water Supply: Public System and name . ................ __ ....... ...... ................... _... . .......... .....Private M Character of soil to a depth of 3 feet- 'Sand n Silt E] Clay Peat E] Sandy Loom C] Clay Loom 0 Hardpan F] Adobe E] Fill Material ____... If yes, type .__....... ...... (Plot plan, showing size of lot, location of system in refctian to wells, bvildings, etc. must be placed on reverse side.) I NEW INSTALLATION* (No' septic tank or seepage pit permitted if public sewer is available within 200 feet,) Ncl PACKAGE TREATMENT f1,11 SEPTIC TANK{) ...... ...... ....... - Liquid Depth ................. Z Capacity Type ... Material.._-_._,._.._.._._. No. Compartments oil" tonce to nearest: Well __ ........ __ ................ .. Foundation ............ Prop. Line..._-,—, LEACHING LINE NJ* of Lines Length of each line ....... .... Total Length ................... -D'I Box Type Filter Material _..___.._.Depth'1f`ilter Material ............... ......... V Distance to nearest: Well Founclati Property Line �n ................. SEEPAGE PIT r j Depth ... Diameter . ............ ..- Numbe-* Rock Filled Yes M No C] Water Table Depth ___. ......... ......_..r.... -..Rock Size ._,.,»,......__..__......_..____ Distance to nearest Well .......... -.Foundation ........ Prop, Line REPAIR; ADDITION (Prev. Sanitation Permit #........,....................»..,.,_.__.._-. Date .... ... Septic Tank (Specify Req6irements) ....................... ...... ....... . ....... ......... Disposal Field (Specify Requirement ..................»....»_.... _..._.._-.._....... -------_..._._._._.._,....._.._.__.......»....,...------..-_.._.._. (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 Joaquin County Ordinances, State Laws, and Rules and Regull"ons of the Son Joaquin Local Health District. Home owner or lkon- sed agents signature certifies the following- J certify that in the porforrr onc,& of the work for which this permit is issued, I shall not employ any panon in such manner as to become, subject to Workman's C pens tion laws of California." Signed Owner (If other than f0R_DEPAJtTMENT USE ONLY ...... DATE _�- . ............ ........................ ............ ..DATE.................. APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED ............ ....... .............. ....... .............. ADDITIONAL COMMENTS . ...... ...... _ ....... .......... '4' * ... * * ........... * ...... ---------------------------- * ...... ............ ........ _ ...... ...... ................................ ................... . .............. _ ............ ....... ........... . ...... ................ ... .... ... ....... ..... ... Final' Ins'pe`ction*by:' ---------- ................. Date . ....... ...... • ..................... SAN IOAQUIN LOCAL HEALTH DISTRICT E, H. 9 1 -'68 Rev. SM