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FOR OFFICE USE:
<br /> APPLICATION FOR SANITATION PERMIT
<br /> �?. ..... ........ . . ......................... (Complete in Triplicate) Permit No. ..,7.6;d.?7
<br /> •... ................................................... .............. This Permit Expires I Year From pate issued Date Issued .r a.:
<br /> i
<br /> Application is hereby made to the San'.Joaquin local Health Pistrict for a permit to construct and install the work herein
<br /> described. This application is mode in compliance with Co my Cledin ce o. 519 and existing Rules and Regulations:
<br /> Joh ADpRss%1.oATlii r ,�'
<br /> !/i-/ ±1. n .. ' � .... NSSIIS TRACT .........
<br /> Owner's Name tYe.. .. .rl ..,.,
<br /> •.• Jj ../l�Phone��.
<br /> Address /..L .,. ., f�4f-Apz.,ld� �:, •:�::, City .,l-��.�.. f•-��. .
<br /> Contractor's Name ,. . , _ ,:...........................................
<br /> .. ..� ,.. .... t . ...... ........ ........
<br /> E ..( ... t. . .,_. ... ................License # .. , ............. Phone ..............................
<br /> Installation will serve: Residencela'-'Cpartment House J:3 ,Commercial OTrallir Court C
<br /> p Motel 0 Other..... .w...•.. ..........:..............
<br /> I Number of living units:- -- ,r Number of bedrooms ,_....Garbage Grinder �TS.,. Lot Size ....... ® A.
<br /> Water Supply Public System and name AAA ' iv
<br /> • e,!•.•! . ,t .4 tY1A!RM!t,,.....• .t., t1 ,..r• •...........r w.r..r• • 1P
<br /> „ '
<br /> 1 •rt�t.1.•...
<br /> Character of soil to a depth of 3 feat, Sand j Silt Clay 13 P , Sandy LCj Clay
<br /> Loom 13
<br /> Hardpan 0 Adobe p Fill M4tertal, If yes,type .........••
<br /> (Plat plan, shaving size of lot, location of system In relation to wells, bAdings, etc. must be placed on rover" side.}
<br /> NEW iNSTALLATipNs (No seg#k tank or seep .go pit permitted if public's+ we is available witltlrti 200 feet;)
<br /> PACKAGE TR �o
<br />� EATMENT � � SEPTIC TANK ._... .� ,
<br /> a � Slee ,�. ,,,... ...... .. .,.,..•......,..., L[qukl Pepto .�.. �p?..
<br /> ........ ...... ....:,.,,. ..
<br /> Capacity Type �? . Ai4ahr moo, Campartmertts � �,,..,...
<br /> Distance,to nearest: Well .......Foun:dation ./................. Prop. Line
<br /> LEACHING LINE, [ I Na. of Linea ....... . Length ale aaiclt lirM. ....�... ., Toro) Lan P ..........................
<br /> - 'D' Box .. -/....... Type Filter Material .� .��.DolitthAter Material .�T..�l.. ...,1 ......
<br /> Distance to nearest: Well ...1 _a.`,....,.. Foundationt ?fri�'..,........ Property Line -�;R—P..............
<br /> 51:EPAGI? PIT [ Qepeft .. ., , Diameter .............. . Number .. ;. . : Rack Filled Yes ❑ No
<br /> ... Water ?aide Depth ............................. ..................Rode-Sive .. .I...... .. I., .... ......
<br /> Distance to nearest: Well -„ .....................................Foundation ........, ....._ ... Prop. Line ......................
<br /> REPAIR/ADDITION(Prov. Sanitation Permits .... ...... Date .,...,.FL .I
<br /> Septic Tank (Specify Requirements) ............................................... ........ . ......_............. ..........................................
<br /> Disposal Field (Specify Requirements) .......................
<br /> .......••--... ...............,..__..g ..... - ........:................ ”
<br /> .........................., . .............. ............................ ....................................................................
<br /> ..................................................................... ............
<br /> (Draw existing and required addition on reverse side)
<br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin
<br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Ham* owner or Iken•
<br /> sed agents signature certifies the following: r
<br /> "1 certify that in the performance e f hich this permit is Issued, I shall dot *mpiay any'persen In such manner
<br /> as to beco u4�too laws of California."
<br /> Signed •. .......... Owner
<br /> BY •--..:- ----------------- Title ----------_ ...... -•---•. .......................••----•-
<br /> (If other than owner)
<br /> FOR DEPA TMENT USE ONLY
<br /> APPLICATION ACCEPTED BY fes -_------- - ..- --• ------------- DATE _10 ..............
<br /> BUILDING PERMIT ISSUED --------------------------------- "` .... DATE ------...._.........
<br /> ADDITIONALCOMMENTS ........... .............. .............••--......---._.....----..__._....._..._...-_._...........---•............---.._..._................_
<br /> ..--...
<br /> .......................... ...........................................
<br /> --. -------------•--••---- ---------------------------•--•-------•..._._ ---------.-._.•..------ .- •- ....._....-----._._._.._...------------...-..- .
<br /> final Inspection by: ........................... fir. . Date �. .. .....................
<br /> EH 13 24 1`613 Rev. 5MSAN J UIN LOCAL HEALTH DISTRICT 8/74 3M
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