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FOR OFFICE PSE: _V1_1'_!:��0________ . APPLICATION FOR SANITATION PERMIT . ....... 0 (complete in Triplicate) Permit No. ---------------_-- ............................. -- This Permit Expires I Year From Date Issued Date Issued Application is hereby made tcthe Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with CPunty Ordinance No. 549 and existing Yule�cl R I tions: / egu a JOB ADDRESS/LOCATION ---0 44s,'.m alxa6 _49v ... ........... Owner's Name e --------------------------------- ----------------- .... .......... Phone ............---•-...............---• Address ..r..---•--...... city.............................. ........ Contractor's Name _.._..____._I_-------- ---- License #/&/t7fA.0' Phone Installation will serve: Residence V<Partment House -7 Commercial []Trailer Court Motel f-15 Other I - ---------------- __ ------ Number of living units-.../. Number of bedrooms _V ........... Garbage Grinder 40,1j9 Lot Size ......... Water Supply: Public System and name _ .................--------=-- ---- ........ .... ._-------•----------- ------------ ------ .. Private Character of soil to a depth of 3 feet- Sand E] Silt 0 Clay 0 Peat E] Sandy Loam -[] Clay Locim'7_ Hardpan F-1 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 seepage pit peri mitted If public sewer is available within 200 feet,) PACKAGE TREATMENT f SEPTIC TANK S, Liquid Depth_________________ 4 7 _71A_ Capacity li Type?Z/yol Material4v-024.f ---- No. Compartments -----9--.-.------ Distance ---- 9 ------ Distance to nearest: Well ................ Foundation ......... _ ...... Prop, Line .................. LEACHING LINE X No. of Lines ------------- Length of each line..._;%—I ................ Total Length 'D' Box %J91. Type Filter Material *116- Depth Filter Material --------- L.- ---- ---------- ------ Distance to nearest. Well 400Foundation Property Line _J77_11 ------------ i Jog SEEPAGE PIT JA Depth Diameter ------- Numbe- .__.Z.-...... Rock Filled Yes No .,0 Water Table Depth . .1116- Ir ---------- ---_------------ Rock SizeS I'll ------------- ---------- Distance to nearest. Well ---- / 0�_ .................Foundation ........... Foundation W_._.-_-- Prop. Line 4- ...... ....... REPAIR/ADDITION (Prev. Sanitation Permit# _ -----_--------------------- Date .._.._.._._........__-----__-__---j - ................. Septic Tank (Specify Requirements) ... _......................................... .. --------•------------------'- .. ..................... DisposalField (Specify Requirements) ------------------ - ------------------------ -------------- ------ --------------------------------- ........................ ----------------------------------- ---------------------- .............................. ....... .................................................................... ............................. ....................:..........__.........-•---- ....... ------------- ---------------------------- ------------------ -------------- * -------------------------- ---------------- (Draw existing and reqbired addition on reverse side) I hereby certify that I have prepared this application and I that the work will be done in accordance with Son Joaquin 41 County Ordinances, -State, Laws, and Rules and RegWatlons of 'the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: -4 "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner as to become subject to Workman's Compensafil laws ofICalifornic." Signed ...... __ ................... .. -- -------- -- ---------- ------ Owner ---- -------- ........ . ..... ......... By ....... ....................... Title ((f other th ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYR a�A IV— ........ ............ .......... __ ................................... DATE ------------------ ............ BUILDING PERMIT ISSUED ----- ----------------------------------------------p-----------••----••--------------------- h ---------------- " ------------------- - -----------DATE --- ................. ......... ADDITIONAL COMMENTS ---- ---------------------------------- ....... 11 ------------------------------------------ ---- ----------- ...... ------------------------- .. .... ........... . ------------ Final Inspection by: a....................... i-- .......................... Date --- to -_130`70. - - 4 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1 -'68 Rev. 5M,