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FOR OFl CE`USE: APPLICATION FOR SANITATION PERMIT --- ---------------------------------------� � �•-, Permit No: r___ --�- ---x (Complete in Triplicate) _ _ x• Date Issued -- ---r-. --_7L / ' This Permit Expires 1 Year From Date issued /s'7-2 3a ? r F. v Application "s hereby nzpdepd' to th ,Sa4coagliancein al'th CaunDty}Ordinance rict for a permit and existing Rules fiand Regulations rein described. This applica ; 4 -----..CENSUS TRACT _----------------------- JOB -- ------- -------------- JOB ADDRESS/LOC ION . �.r Phone _ Owner's Name - � � e ..__ r # ---------------- Address ----------- - ---- =1} ��.�� p� Contractor's Name - ��- .=�-------------------------------•---------.LLicense #�_ f�-� - -/".Phone - --- --'-�-•- - - Installation will serve: Residenceartmanfi House❑ Commercial'❑Trailer Court ❑ Motel ❑Other -------------------------------- ---------- Garbage Grinder s Lot Size .f Number of living units:-----------/Number of ,j,omsr..z-_____. C ,_Private ❑ Water Supply: Public System and name _____ --------- --- - - ------------------------------ -Private of soil to a depth of 3 feat: Sand ❑ Silt Cla ❑ Peat 1:1 Sandy Loam ❑ Clay Loam.❑ Hardpan ❑ Adobe Fill Material _____ C21f yes,type --------------------------- W {Pl'ot plan, showing size of lot, location of system in elation to' webs, buildings, etc. must be placed on reverse side.) �, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available ilable within 200 feet PACKAGE TREATMENT [ ] SEPTIC TAMC: zed_- /_ ---- ---- Liquid Depth j Compartments -••- ' T e C i`�Materia P ` . YP / Capacity -! ---�--,------ -- " -----Foundation - ��--r---------- Prop. Line - .:--•---- Distance to -nearest: Well ______ _ _____ ____ ti� ""� I I' - Length o each line.. S, .-1----- Total Length- --•----• LEACHING LINE [ No. of Lines ------ " C 't om -_De-th Filter Material _ Lt--•----- �- 'D' Box ___- _�- Type Filter Material � j- P�. � 'rte--1 ion LJ ----------- Property Line.----- Distance o nearest. Well's-__�___ __-- -- Faundbt �- ---------- --- Numbe'��----f - Rock Filled Ye ] No ❑ 1 SEEPAGE PIT [ Depth --- Diameter= --•- Ro ! / f Water Table Depth 16 ,1 ------- --------Roc4k Size f �2"� --- Prop. �- - Distance.to nearest:,Well ----------- TION ________'` - ---------- -----------Foundation Prop. Line ._REPAIR/ADDITION(Prev. Sanitation Parm"t 4 -------- ^ - Date - ----------------- 1 f Septic Tank {Specify Requirements) ---------=---------- ------------------ ----------------- - r ------------------------------ ---------`; .Disposal Field {Specify Requirements) -------------------- ----------------- - ' -------------------- -------------------------- - -------- - {Draw existing and reciui-rediaddition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin I Local HealthDistrict. Home owner or 4icen- County Ordinances, State Laws, .and Rules and Regulations�of the San Joaquin ` sed agents signature certifies the following: f ; "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 I;ecome subject to Workman's Compensation laws of California" .. � t `' � ---�- ------ Owner Signed - /- - ------Title --- (If other tha o er " FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY._ �; DATE _ . ___ _-- ��_ . ------------------ DATE - - , BUILDINGPERMIT ISSUED-------_--.-�-----------------b----------------- 1` _ ------------------------- ------. -------------------- ADDITIONAL COMMENTS ---------------------------------- ------------ ---=------------- " -----------`---------- - ------------- --------------------------------- - ------------------------------------------ --•"�y--- --- ---------- �.. - - -- �.� t . - ---------- Date ------- F-inal ------Final Inspection b - - ------ = � - - - - - ----- SAN JOAQUIN OCAL HEALTH DISTRICT ' E. H. 9 1-'68 Rev. 5M _