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FOR OFFICE USE: f l� APPLICATION FOR SANITATION PERMIT -� 1Permit No. % 'D ----- (Co- in Triplicate) ,^ ------------------------- Date Issued 1 'Tlir's Permit Exp ires Y Year From Date Issued --- -- -- - - --- t Application is hereby made to the San.Joaquin Local Health District for a permit; to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 5�9 and existing f ules`and Regulations: a � , 1CENSUS TRACT _"-_."""- JOB ADDRESS/LOCATION - - � fd 4 i Owner's Name � Phone , -- --------- } .�f `... � r itY Address .. e'"� ' / one �!'.- Contractor's Named Commerc aIS�+Tra�lj h Installation will serve: Residence rtment House❑ [Q Court RC1 Motel ❑ Other ---------------------------- - s t Q i ---- ---- --- --- Number of living units:._ " -" Number o edr m -Garbage Grinder = Lot Size SdP. "-.2/1 E --------- ------Private ❑ Water Supply: Public System and name Et "" f----------- --------------------- = Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ lay Loam.E] fHardpan F1 'Adobe -I-] Fill Material ___.----- If yes, type ._- -_---_------------- (Piot plan, showing sizelof lot, location of system in relation to wells, buildings, etc. must be placed, on reverse side.) NEW INSTALLATION: (No septic tank or see a e it permitted if public sewer is a�ilable within 200 feet,) .. PACKAGE TREATMENT f;] SEPTIC TANK!f e-_ _ ___ _ "" _ _--__-_-- Liquid Depth --- .- T e Mdterial__ -- --- -------- o. Compartments r•------ Capacity -- -__-:-- YP Distance to nearest: Well ---_-_-" Founddtion __ ___-_"---Prop. Line - -•-----•-•--- LEACHING LINE No, of Lines�---------- g ch liners -- - - Total Length ------•-------- l�{ _- Length of ep , . 'D' Box "�,---(3Type Filter Material Material - Pth Filter Material _ _ ___ __________________ _•=--- w -De � - ` Foundation - ----___-- Proper Line ._�•_------•------ Distan� to nearest: Well ____ "- --___ `------ tY SEEPAGE PIT Depth --- Diameter 33.""--_ Number - .<- ------------ Rock Filled Yes No C] f Water Table Depth-------------fes - = Rock Size_" Z Foundation"'�/��__f_--- Prop. Line _ _�._-__-. Distance to nearest: Well ---------------------------------------- i ..REPAIR/ADDITION(Prev. Sanitation Permit# -------•------------ ------------------- Date ------------------ t 'Septic Tank (Specify Requirements)-------------- ` t - ------------- ------------- ---------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------------ -----------1--- -------------------------- ------ ----------------------------,--------------,------------------------ ------------------------------------ ----------------------- ~ ---------- ---- --- - ------------ i (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 the San Joaquin Local Health,•District. Home owner or liven- sed agents signature certifies the following: I "f certify that in the performance of the work for which this permit is issued, I sholl,not employ any person in such manner as to become subject to Workman's Compensation laws of California." + ,� ,e Signed r ---- > T - __ -------- ------- ^ Own Owner - T - u/sk i#le If ot FOR .DEPAATMENT USE ONLY DATE ." — -------------- APPLICATION ACCEPTED BY -._"" ---------- ---------------DATE ---'--------------------------------------- ADDITIONAL ----------------- - �BUILDING PERMIT ISSUED "-"_ -• - ---------- ------ ADDITIONALCOMMENTS. ------- ------------------------------------------------------------- ------------=----------=--------------------------- o -------------------------------------------- ------- ----------- ------------ ------ ---- --- --- ----------- ------- - b_ ----------------------------------------------------------------------------------- __ - a Final Inspectiori by ------ -------------- JN --- ----- Date - ----..- .. �. � '�'•.'� AL- HEALTH 'DISTRICT SAN J OAG2t Mi :LOC , i E. H 9 1-'68 Rev:`5M