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FOP. OFFICE USE: APPLICATION FOR SANITATION PERMIT ............I............................ Permit No. lCornplete in TrIplicatO I- VV ... ................ V p—11— -3 1 ...........4 . .. ...... __...... This Permit Expires I Year From Date Issued Date Issueci Application is hereby made to the Son Joaquin Local Hean ]District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.. 11211 1..N0 ....... .. CENSUS TRACT .............. JOB ADDRESS/LOCATION ..........-.1-1-- ..... .....- Owner's Nome _ R-- POIPq........................__--------------------- Phoneg,5 1,...2027............... Address 7620- T!a....E1Zk=ad.0............................................—City ............Stkn. ........................................................ Contractor's Nome '2-lackard'8 Septic Tank.... .....................license# ....269951... Phone _461m7a4a..— Installation will serve. Residence [Apartment Houn 0 Commercial [jTrallor Coud C] Motel 1`7 --_----_-----_- Number of living units: 1 Number of bedrooms Grinder Lataft ...... Water Supply: Public System and name . ............-...................... ....... -....... ........privalet] Character of soil to a depth of 3 fact: Sand E] Sill ❑ Clay ❑ Peat El Sandy Loom E] Clay Loam E] Hardpan Adobe L] Fill Material If yes, type [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on rexerse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] �'.X64X10 ....... ... Liquid Depth ... PACKAGE TREATMENT SEPTIC TANK size__.. . ............-...... ........ Capacity 1200 Type Matstriall....-COn' -. No. Compartments Distance to nearest-. Well ..........5JV_____Fobndaflon_-.101 Prop. Line LEACHING LINE [-A No. of Lines 2. Length of each line.' Total Length D' Box A-...... Type Filter Material 2 _.Depth Filter Material . . ...... .1.V....................... 1000, Distance to nearest: Well ..loln-.... Foundation 20 ...... Property Line ...._.................. SEEPAGE PIT Depth .. - Diameter --3,3!t.-.-- . Number .... 2 Rock Filled Yes:0 No (:1 Water Tabli Depth Size ........ ....... Distance to nearest; Well Fou ndot ion ........P1...... Prop. Llne REPAIR/ADDITION(Prev. Sanitation Permit# .......................................... . Date ..........................—.1 Septic Tank (Specify Requirements) ...... .............._............ .............................. Disposal Field (Specify Requirements) A. -Q_). ........................................................................................................__._____..._.__......... .................................. ..........rax......w...e.............___ . .1......... JDisting and required addition on reverse scoot I hereby certify that I have prepared this application and that the work will be done in -accordance with Son Joaquin County Ordinances, Slate Laws, and Rules and Regulations of the Son Joaquin Local HecillS District. Nome owner or licen- sed agents signature certifies the following. "I certify that in the performance of the work for which this permit is Issued, I *hall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Owner By . C on t r.a.e t.o.r................................... Ilf other than owner) FOR DEPARTMEW USE ONLY APPLICATION ACCEPTED BY ............................. DATE ------ BUILDING PERMIT ISSUED ...................._------ .................._DATE ..................---- ADDITIONAL COMMENTS ........................... .................. ............I---................... ................................................. .......... ...... ................................ --------------------:.............. ......... .......................... ....................... ................ ................... SAN JOAQUIN LOCAL HEALTH D115TRICT E. H. 9 1.'68 Rev. 5M