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FOR OFFICE USE: .� "" APPLICATION FOR SANITATION PERlWIT I 4 � ' a �. -;. Permit No. ....... .. _.. .._....-.1- e,. ..._� ._. _. �' (Complete in Triplicate) i ................................... Date Issued ._��75� ........ This Permit Expires i Year Fro Date Iss ed l the work i Application is hereby made to *eo J aquin caeoun �stnct for a p r i�g a existing Rules�lestalnd Regulations:ern 1 PP P ce No. 9 ' described. This application is made in compliancerwith �y Or inane{� CENSUS TRACT ...............--:........ .SOB ADDRESS/LOCATION- � ® .• iTf � � Owner's Name _d,l .. 1✓ ll_�r/ 4'•lf I� l�lt� Phone .a ., .3 ... 'F. i � -•---•.... -------- ._......----_.. city _. . .......--- ........................ Address __.. Contractor's Name ./_ _ .L.l .. QD%, � •----- ----------------------------License #o .��' 1--• Phone r Installation will serve- Residence 'Apartment House Commerciale❑Trailer Court 0 � Insta a Motel ❑Other ................. -------....-------•------- I Number of living units:.../_..._ Number of bedrooms Garbage Grinder ��-- Lot Sire f 15.-.�? ...................... 3 Water Supply: Public System.and name .................................. •.. _...._...- Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .0 Clay Loam ❑ Hardpan [] Adobe..] FIII'Material ------------ If yes,type ---------------------------- i (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) r NEW INSTALLATION: (No septic tank or.seepage pit permitted if public sewer is available within 200 feet,) r j PACKAGE TREATMENT [ ] SEPTIC TANK Sizef�J'�f�, r� '-------- Liquid Depth 1.�...................Id Capacity Ilee..... TYpe� .. No. Compartments ;;?;.-................9 Distance to nearest: Well ------,Z9__. .................. Foundation`. ...._.. Prop. Line ��. ........... 11 LEACHING LINE No. of Lines .._ .........-_-• Length of each line. _--- •-_-----• Total Length ,l f. ..•••••-__...... I 'D' Box . Type Filter Material � %�e � s Depth Filter Material le...................•---...........� �-� Distance to nearest: Well ��.............. Foundation _.vim... _ Property Line/1J...-..-........ •.-- SEEPAGE PIT Depth ..a .dl DiameterNumber - Rock Filled Yes,& No41 .61 i[7 Water Table Depth .__ `� ................ ...................Rock Size ................ Distance to nearest: Well ._..._f - -••-•.••--• ...Foundation /l/f........_ Prop. Line ? ---•---••-•-... fREPAIR/ADDITION(Prev. Sanitation Permit# ...•---•-__.--------------------------------- Date ...... -------•---•-•••----•--•--) Septic Tank (Specify Requirements) ----••-----------•-____ ----•---•-•---------•-••....................................................................... -- Disposal. Field (Specify Requirements) ........................................ ------------------------- ----------------------•---------._.--------- ----- ------- --• ----.....-------....------ ............. -••----------- ........................ •... -•--------------- ----------- ------------------_---- --------------- ------------•----------••--------_....................................................................................... (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, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- 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 become subject so Workman's Compensation laws of California." Signed ---------- ------ . ------._.... Owner By ................ . . . Title?,0177?"41 ... . .................... . .. (I er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. y ......... •••-•.....-•-••-..... ......... DATE ......1-)`�71-ki----.-------------- . BUILDING PERMIT ISSUED ....... ..................... -•-•. .......-- ., - ........................................................ DATE ... 4 ADDITIONAL COMMENTS ---•. ...............................: .......Date ................................. • .. ...._._____. y. Final Inspection by: ..............................................................-----....__. . J DISTRICT SAN.JOAQUIN LOCAL HEALTH _ .. 1 -4 9A - 7/72 3 M