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FOR OFFICE us : APPLICATION FOR SANITATION PERMIT > . .......................... ..........__.... '' .:. ....75...__�•� (Complete in Triplicate) Permit No. --------------------3..................- "' Date issued '�.. -+•t�. -,�� .................. Yl�0 This Permit Expires 1 Year From Date 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 made ' compliance with County Ordinance No. 544 and existing Rules and Regulations: E. Hildreth Lane 108 ADDRESS/LOCATION .......,. ..------..................................................... _ . CENP one TRACT , . c . . � r Owner's Name ....... ....................•--•--•-..,.,-------......--=••-•-------•-_..... ..........._................ J�J N S an so aquin Address ......................... City --•-----.......271,539........ y _2 T�....... R ._... Sw��"Sed: Contractor's Name Roto Rbot�'x�' License # ... Phone ..:........_ In will serve: Residence fn Apartment House 0 Commercial Trailer Court 0 Motel ❑Other ......................:.......•----......_... Number of living units:---- ------- Number of.bedrooms---4.......Garbage Grinder _.��s__ Lot Size ----------------„---_: Water Supply: Public System and name -------_----.-••-.. -------•.,..... ------------._......................_..............................Private ®x Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ' Peat❑ Sandy Loam 0 Clay Loam o 4 Hardpan Adobejo Fill Material ...n.0.... If yes,type -----------------_--------- (Plot ---------------------- -(Plot plan, showing size of lot, location of. system .in relation to wells,kbuildings, etc. must be placed on reverse side.) , NEW INSTALLATION: (No septic tank or,-seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f9Liquid Depth ...... '..•--......... o Capacity .1600.--•-•--- Type pr.0...c-as-tMaterial..c6.nar,&•e No. Compartments ...................... OV Foundation T Prop. Lind Distance to nearest: Well _1�.....P ?�s............. 1• ..... } ..... } �y LEACHING LINE [ No of Lines --- ----------------- Leng#h of ea line.-- .-:----...--. *notal I�gWh _._._..-.f.. --___-.. yes ro ct __ D' Box .i"Type Filfje'M_tefidl'""" :Depth Filter Material Distance to nearest: Well ..... Q i___P,lufoundation W_--------------• Property Line .. ............... . ` 25' I 88 3b'„ 2 ji by 3k+ Filled Yes No s EPAGE PIT [ Depth �_....__.... Rack Size ....... . .--- .---•----- ..... SE Diameter Number `-` Water,�Table,D pth .. Distance to nearest: Well _-__.___ t... _ Foundation ....... Prop. Line 5.1".”.......... 3 REPAIR/ADDITION'(Prev. Sanitation Permit# -•---..•...........................••---•... Date .............................. 'Septic Tank (Specify Requirements) .............. -------------- -------- ' ..........................._.................. Disposal Field--(Specify Requirements) ------------ ......-•-•---•._.__. ........-----------------•--... -••-•-•--._....----........--------- ' - --------------------------• •----•-----• - ---- --------._.....-------------•--- ------ -•-...-----•----•-••• ------- I i ~ (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 Regulations of the San Joaquin Local health District. Home owner ar Iicen- sed agents signature certifies the following:. . -r x °'I certify that in the performance of the work forhich this permit is issued, I shall not employ any person in such manner as to become subject to'Workma fs Com ensatiod laws of California." r Signed g "--- --- ---- -- ------. . Owner B - - --- -- ...... --- ---- ------Title -�,��.,... ...... leel (I er than nerj F R DEPARTMENT USE ONLY ` APPLICATifE ACCEPTED BY ..... .... ................................•-••-. DATE ..- f Z. . _.7 ......._.. BUILDINGMIT.ISSUED ...... DATE .....:.. ADDITIONAL COMMENT 52 lT-S ----------------• ............•-•.............w.......:.: . ---• --------------------------------------------------- ------•------------••------•--.....--........----_-•-_.. ..-----••••._............... ---•---•----... .....:......:................................... w ::..... ------•- Dat....._ Final Inspection b r� P y --- -• ....... ............................. e ... •2 /."'- # _ -� .s 'SAN JOAQUIN LOCAL HEALTH DISTRICT r � j 7172 3 M