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FOR OFFICE USE:, APPLICATION FOR SANITATION PERMIT permit No. - Ic45-1 i ----------- ------------- (Complete in Triplicate) _ Date Issued -�� - -�� This Permit Expires 1 Year From Date Issued -------- --------------------------------. it to ct and e work Application is hereby made to the San Joaquin Local /�Hie Cou ayt�dir�arn a No�549 and exi�sti g Rules described. hRegulat Regulations. I pP described. This appl;catio is made in compliance �CENSIJS TRACT ' - - - -------------------------- Phone ------------------------------------ ----------- JOB -------------•--•--------PhoneJOB ADDRESS/LOCATI Owners Name N ------- � - ---------------------- city - --- - Address ----------- ----- - Phone ------------------------- Contractor's Name . -- ---------- --- ----- ---=- -----License # ----- -; - ----- - Installation will serve: Residence F-1ApartmentHouse❑ CommercialTrailer Court ',[] Motel ❑ Other ------------------------------------------•- Garbage Grinder ------------ Lot Size ------------------------------------------ Number of living units------------- Number of bedrooms ----Private ❑ -- ---•--- ---- -- - - cim. - -- Water Supply: Public System and name _-"--------- -------"---- - - - -. Peat Sandy Loam; Clay Loam.: Silt Clay ❑--�❑ _. .�_ Character of soil to a depth of 3 feet: Sand'El— ❑ ,,.. „ .." Adobe ❑ Fill Material ------------ If yes,type ,-------------------------- Hardpan ❑ \ buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system ;} relationetd f public sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or seepage p p � f� Liquid Depth ---- �----- -- Size---. SEPTIC TANK -- "`" --- -- - PACKAGE TREATMENT [ ] -- -------.----- Ca acit /f04 • TYpe0--- --"�°`rf Material" '4-' No. Compartments Foundation -1� Prop. Line ---- -- Distance to nearest: Well fAqjV'T, �. Total Length --- K LEACHING LINE [ ] No. of Lines Length of each line___- _" e D' Box _ 14 Type Falter Material �-Depth Filter Material _ - - f I? Property Line J--------------•-= Distance to nearest: Well "1��- -- Foundation -- 1------------- SEEPAGE PIT [ ] Depth Diameter ---------------- Number -------- ------------------- Rock Filled Yes ElNo t Water Table Depth ------------- - -- --------- -------- --- - "-----Rock Size - ------------------------------ Distance ------------ ------Distance to nearest: Well -""_"__"------------- - ------------ - Foundation ------------- -•--- Prop . Line ---------------------- Date -•-----------•---•--- Date ----------------------------------) REPAIR/ADDITION(Prev. Sanitation Permit ------- ----- ----------------- , r' ---------- Septic Tank (specify Requirements) ----------- - ------ -- -------------------------- Septic -------"_- Disposal Field (Specify Requirements) --------------------------------------------------- ---------------------- --------------------- ----------------- --------------------- ------------ I i-------- ------- -— - - = -- ----------------- ------------- - Draw existin 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 the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: erson in such manner I "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any p as to become a to W an's C pensati.on laws of California." -------------------------------- Owner Signed ------------------- --------------------------------- - - - -------- -- ------------ - - - ----------- ----- -------- Title ------------------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY DATE ------ --------- --------------------------------------- DATE --..-.------- -------- APPLICATION ACCEPTED BY " --- -- -- -- - "-""" - - " """----" --------------------------------------------------------------------------------- - BUILDINGPERMIT ISSUED -------------- -------------------------------------------------- ADDITIONAL -- -----"-- -=------------i " ADDITIONAL COMMS ------ ----- ------------- - _ ------------- -------- --------- -- /_ l- _�-- -----•----- ----- - ----------- ------------------------------ -Dated- �2 ----------------------- ----------------------------- Final Inspection by: -" -L� - � - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M