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cY: Pl FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .."" (Complete in Triplicate) _`_ .....................I__.....--. Dote Issued .` ••• _..-...._.-.-. ................ This Permit Expires 1 Year From bate Issue ruct and l the work is hereby made !o the San JoaquiLocal ith Health tytOrdinance for a Noer m549 and existing Rulesit to const (alnd Regulations- Application rein described. This application is made in compliance JOB ADDRESS/LOCATION f Q.i.. � .....--•- CENSUS TRACT .1�-._... �_� •�''C-••��- ................Phan"e_�� `-�.•t. STSOwner's Name 'I f �f/ /............................ .....-_... / , .. City _ Address Phone h Contractor's Name .._/f ..sr.. .License # _ -- ne � • �- � I❑Trailer Court Residence� Apartment House❑ Commerciae Installation will serve: Motel ❑Other -..------------------------------- - --- r1 1 Number of living units:.-../..--- Number of bedrooms ----I.....Garbage Grinder ./S/�.-- Lot Size/�� :�---- aIY�•-- ••-•--... ; Water Supply: Public System and name .............------------------------------------------.---.... r .................Private ❑ .. f Peat Sandy Loam ❑ Clay Loam,❑ Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ ❑ , a '. K Hardpan ❑ Adobe jZ Fill Material -........ If yes,type'...... ...... ;` --- , l -r- Iacedon a reverse side.) 4 - (Plot plan, showing size.of lot, location of. system in relation to wells, buildings, etc. 'must -be p No septic tank or seepage pit permitted if public sewer is available within 200-feet'f l.., NEW INSTALLATION: p p Siae------• �------ PACKAGE Depth ........................... PACKAGE TREATMENT ( ] SEPTIC TANK f ] •-------•-------•-------_--- S Material.. .. No. Compartments= Capacity ------------------ Type -•-------• --- ., --Foundation ...............�------ Prop. Line ----• `........... ... Distance to nearest: Well ••----•--• 1. 1 Total length ...............:;..... [ ] No. of Lines Length of each line.-- ----- � ri \ � y LEACHING LINE - .....De Depth Filter Material -------------- ......... 'D' Box .... Type Filter Material .......-----••- p �. .... i Properly-Line ..:. •• Distance to nearest: Well .................•------ Foundation ......-.. t 6 I L ----•--•-----••- Number .... --....._---••-•. Rock Filled Yes ❑i No CI O Depth Diameter SEEPAGE PIT • � Water Table Depth """ Pro line .............. Distance to nearest: Well --••-- .............Foundation - fR:PAlR/ADDITION(Prev. Sanitation Permit # . .--•••••- ---------------- ------- Datej .................................. Septic Tank (Specify Requirements) ................... -------------- .............. ............... ........... Disposal Field (Specify Requirements) ......... r I .... ----------- -----•...-•- i _..-.-..---•--•------..---•--------•--••---•-• •- r I -------------•------••---....c......_.............. _�� = .......--..... .._.-...__... ••------- ------ (prow 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 I % Rules and Regulations of the San Joaquin local Health District. Home owner or licen- County Ordinances, State laws, and 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 i as to become subject to Workman's ompensation laws of California." - Owner Signed .. . ..... ------- e ------ Title ... (If other than o er) ) FOR DEPARTMENT USE ONLY Y......-_ Y. : �-- ._..... - DATE ... --•- APPLICATION ACCEPTED BY .......... ...... ... .• - -• DATE BUILDING PERMIT ISSUED - ........r. -.. ...... -- ................................................. ................. .......111. ADDITIONAL COMMENTS ..- l ................. . ....... ....... _ _ �y.............. ..............•-••--...............-...-•-- ..._..:.... ...................... ••••._._Date-.... ..:0• -... ,( i Final Inspection by: ------- -.'..... .. ..............•_--- 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 7/72 3 M x