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FOR OFFICE USE: : 0-_!�f'•_•.•:_ ApPL1CA�lON FOR SANITATION PERMIT Permit No. . ................. • •• - (Carnplet•In Triplicate! �, r - ..........I.,....... ......... This P Date Issued .. :��_..J ...... .... . ........................ .... ..........• ..r Permit Expires 1 Year from Date Issued Application Is hereby made to the-Son Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 1008 Will-ora' JOB ADDRESS/LOCATION ! _..•..... ......................CEN5US TRAGI .......................... Owner's Name ..He.mala---0vertQa------------a--- ---------=-......................I.......... Phone ---------•---------••-------------- 1008 Willora :......:....... . ........ - .... _ ...... C€ty _._.. .._...._---•-•....:..--- ---------------------- Address - Contractor's Name 'Roto tooter Sewe'rSi3 -- 271539 Phone X65-2�a6� --- --- ---------------•--••- •-•..........._...............:...__...license 9!r' ....._.... - . t Installation will serve: Residence®Apartment House J] Commercial OTralkw Court 0 Motel❑Other............................:.......:.....:. es 100 byl0o Number of living units:....1...... Number of bedrooms 4.........Garbage Grinder --•-•---..-_ Lot Size -_--_____ .............•------...._..... Water Supply: Public System and name .t a-_-ba_.ho ak_ad...t a... .. ._-_...........:.......Private p- Character of soil to a depth of 3 feet: Sand r] Silt 0 Gay ❑ Peat❑ Sandy Loam 0 Clay Loam E3 Hardpan 0 Adobe[T Fill Msrterlal hQ......If yes,hype............... ............ (Tot plan, showing size of lot,-location of system in relation to wells,,buildingi;etc. must be placed on reverse side.) NEW INSTALLATION: -(No septic tank or seepage pit permitted if public sewer' is available within 208 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ 3 Size................................................ Liquid Depth ...................: Capacity, .................I.... No. Compartments --•----• TY i Distance,to nearest: Well -,..................................foundation....................... Prop. Line ............... LEACHING LINE { J No. of Lines ------- _-------- Length of each line............... ............ Total length ............................ 'D' Box .= Type Fitter Material Depth Filter Material .............................................. Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT ; ] Depth _ ................ ......._....._:,..__.....•- -•�--...... -•--------------- •----..._....-----•--•-•----.Rock Size ---.._...._.:.........-----filled Yes � No Q _------. Diameter Number hock F Water Table Depth -• -- Distance to nearest: Well :...:...........................:_.... ..FoUndatlon ..._::........:..::. Prop. Line ........._........... t i REPAIR/ADDITION(Prev. Sanitation Permit# :...................................:-------- Date .................................... ) ... ........._._ . Septic Tank (Specify Requirements}.-----------------------............................................................�._.........--------...._... .- --- - Disposal -Field (SpecifyryRequirements) ----• in...i e,ar---.af...........••--•....:_ - home: with neer -pre.--cast 1200 .g,allon, concrete septic tank-Well___too•--._.•••.....:....... .- -- close. to septic so owner is hooking toCalif. W9.ter Sera ------------------------------------------------.................................. ----g-......_--................... ................ (Draw existing and required addition on reverse sidel 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. Nome owner or licen- sed agents signature certifies the following: , "I terrify that in the performance°of the work for which this permit Is issued, I shall not employ any person In such manner l p s of California." as to become subject to Workman's s Com ensatian law Signed ............. :... ...........---------..... Owner BY tie Contractor Ti -. (If an owner) FOR DEPARTMENT USE ONLY APPLICATIO CEPTED BY %__ .. .-- DATA:..- BUILDING PERMIT ISSUED --------- -------------------_-4r..fm..............................................................._DATE ..... --------------- ---------------- ADDITIONALCOMMENTS ...........!....................................•.........................................--:.................-•-------------------=---• ....-•----......... ................ ........................... .....-_i --- -- -------------.._..------ ..... ---- -- --- - ---•---•-----.-- ............................ ------------• --- ..... _j11-1-9171-11 '`. Final Inspection b - ---------------•----•---- Date` 1-1.91/.....-.-... la Y= G'' EH 13 2t+ 1-68 l SAN JOAQUtN 'LOCAL HEALTH DISTRICT 8/74 3M