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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT Permit No. .T�`.��/• ........... .......................... ---------- Triplicate) _-_.. -..-. 1 p p,..........-. _ , -. _. . w � .� .�.. Come lets in Tri .�,- _-...._.:_....:-_:..:--_:..., This P ......................... . . p a.:.��_.7 7 _ Permit!rx fres 1 Year From Date issued Date Issued . Application is hereby made to the San Joaquin Loca! Health District for,a .permit to construct and install the work herein described. This a p ' ce with County.Ordin to No. 549 and existing Rules and Regulations, application is made in com .CENSUS TRACT ... JOB ADDRESS/LOCATION ..-F+7-1-- t -- -�.... ............. i ..... ...Phone Owner's Name . 3. :1I./j....gs.rf3 :.,....._.......... . !r� •{, (C1'2..... E -- ... ........... ......................... Address ...... City -_..License � 3..... Phone Contractor's Name ---. , •;------ .. -,..�-�.....,. � ... Installation will serve: Residence�Apartinent House❑ Commercial❑Trailer Court r . Motel ❑Other ........ ............... Number of livingunits•-`-. Number of bedrooms Garb a Grinder ...........:- Lot Size ..'.P-. .... . .. r _ ... i ...... a Water Supply: Public System and name ..- __�� -:x..:. :._... - .........�...-.:..................... v ................ ................. i ..Private Peat Sand Loam Clay Loam ❑ Character of soil too depth of 3 feet: SandIC] 5ilt❑� , Clays Q, ❑ Y {� Hardpan Adobe 1=iH Material ............ If yes'type (Plot plan, showing size of lot, rotation of system,in relation to we4ls, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted d�public-sewer•-45^Qvaiiclble within 244 feet,) r ' cak P . Liquid. Depth PACKAGE TREATMENT [ ] SEPTIC TANK n ... . . Material No. Compartments ......... .. Capacity �-'�Q,O. TyJppeEe. ............. Distance to nearest: Well -.LO®.-. •. .... Prop. Line U....._. - .:Foundation . ..:�.......-... Len th' f each li e.... �--�....... Total Length ....-l7 � LEACHING LINE r No. of Lines .-- - .-...: g V. Box ....L_... Type Filter Material ..:. Depth"Filte®Maternal ....1_.�....... ... ! bistance to nearest: Well .:..• — - .... Found ion. ..... ................. Property Line .-.... .. �[5 �`i/ �¢� Number ..._...---. �..: .:..... Rock Filled Yes No C SEEPAGE PIT Depth -- :- •-•---- Dianneter a Water Table Depth f Rock Size• :.. .. ._.. .. ......foundation _.f.�_�.: _Prop. Line ....••• . Distance to nearest: Well ---=• REPAIR/ADDITION(Prev. Sanitation Permit# ` .......... •-.-•-. � ------ Date�.................................. ) Septic Tank (Specify Requirements) . ...........................--............................................... -------........................................... Disposal Field {Specify Requirements) ---------•••----•---•-------•-------------- ............................................-...............I.............................. ..... ------------------- -.....------ ----•-•-•-- -•..........._,...__.... 1. - (Draw existing and required addition on reverse side) 1 .hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin r County Ordinances, State Laws, and Rules and Regulations of the San Joaquin, ocal Health.VIstritl..Hom9 owner or licen sed agents signature certifies the following: r "t 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 subje Workman's C mpensatio laws of Q"fomia." I Signed -- ............ BY -------------- --•----------------------------------------- ---- i _ t'.... �'itle __..-- I (If other than owner) DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY ------,5 - -- -- _ ` .:_.•_.__------- ...._,...,.DATE,. _ BUILDING PERMIT" ISSUED � DATI` -.------- --- ADDITIONAi COMMENTS ..__.._._._.. .. ... . .................... .._ ..... � -• ...................:--------------. ------... �.... ......................... •...._-..-... ---------------------------------------- •-- •-•------------------ -•---•--••--: -..._... _ -•--•--...__._. �. Z ------------------------------------------- . Final Inspection _- Date_ .. --.:. -_ ' -.. Eli 13 24 1.68 liev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT h 8/7h 3M