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FPR OFFICE USE: • APPLICATION FOR SANITATION PERMIT Permit No.�=�-r•,--�� ----- -------------- ------------------------------------ (complete in Triplicate) _ -=- --_, Date Issued �l�'��.'9 ' ------------------- - -- } ------_----------- - This Permit Expires 1 Year From Date Issued ` --------------------- it to construct and install Application is hereby made to the San Joaquin Local Health District rde for a erm549 and existing Rules and Regulations: descried. This application is made in compliance 'th County ------CENSUS TRACT ------------------- ------ JOB ADDRESS/LOCATION ------------------ - -Phone .-- - fr� ---------------------------------- - Owner's Name a -G ---------- ------- ------------• --- 7 Cit j�'+ G� -------------------------- „r,y_ �[! ------ -- -- - , ;'c �;- 1 .�. - Address t - '. ',' Phone9_347�3 Contractor's Name -7 Installation will serve: Residence XApartment House 1❑ Commercial ❑Trailer Court k Motel ❑ Other -------------------------------------------- _ ,�. _� , .. ------- ss Number ofrliving units:_..._ Number .T_6 drooms --- Garbage Grinder - Q._-.. Lot Size -_-- --- -- -- = = --------------------- -Fri Private Water Supply: Public System and name ------°=-`--------- Silt Clqy [] Peat F-1 . Sandy Loam ❑ Clay Loam_❑ _ Character of soil to a depth of 3 feet: Sand'❑ ❑ - �. Hardpan-[D Adobe X Fill Material ..__. Y---�If es; 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 permitted if publics e r is available within 200 feet,-+ 11 fI ! --,----- fl_. -.-- Liqukd Depth --- ---- -------- PACKAGE TREATMENT [ ] SEPTIC TANK .:Size_ � "��=� �7 o T e � Material �- -- No. Compartments -__----Z------="-- "! Capacity -t�----- = t YP r f _ Foundation ------�-� Prop. Line ._------- --- Distance to nearest-Well --_��---------------- ------ e ,. p --------------- Total Length ---�-- --��------•----- LEACHING LINE, No. of Lines > 7---------'---- - Length f each line.___d-- .... �_ ___ Depth Filter Material ..._-[--9- - - - D' Box TYPe Filter Materiali p T Distance to nearese -----------= --- -- -= at�n"°"�------- t Depth Diameter ---------------- Number ---------------------------- Rock Filled Yes C] No SEEPAGE PIT L ) p �---- ; ! Water Table Depth _. ---------------Rock Size ---------------• - Distance.to nearest: Well ---------------- Foundation -------- ------ ---- Prop. Line _-----------------— t ----- --------- Date ----------------------------------) REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------ Septic Tank (Specify Requirements) -------------------- ---------------------- = . ------ Disposal Field (Specify Requirements) -------------------------------------------------- ---•-------•--------------------- - --------------------- - --------------------`---_------------------------ ----- --------- ------------- _ _ 4 ------------ ---=---------------._�.------ ------------------ ---- f' = —------ {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 San Joaquin County Ordinances, State Laws, and Rules and Regulations of,he,5an.Joaquin.Local Health-District.-'Ka-me 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 shall not employ any person in such manner as to beM%Mbjg'tpLV6?j d;sg�NZati.on laws of California." Signed --- ---------=' --P-Q.-Box.254--------------------------- --- -- Aw, X160 Cast Grantline Road ------- - Title .c� �r ----------------------------------------- - -- . --A5 -------- - 537ki ' FOR DEPARTMENT E LY APPLICATION ACCEPTED 8 -------------- ---- DATE __---- ------ ------� BUILDING PERMIT ISSUED --------- ------- DATE -------------- ------ - ---------------------------- ADDITIONAL COMMENTS ------ ----------------- ---------- - - ------. !------------- ---------------------'- ------ ---�-• - --- -- ---- ----- --------- -- ---Final Inspection ------ --------- ----- ------ ----- --------------------------- Date -- --- 1brnVi31 '. SAN ARICT r E. H. 9 1-'b8 Rev. 5M.