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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....•................: {Completo in Tripticatel':. M .. Permit No.,. :..... Date Issued .la_:.._... ` ........................ . This permit Expires t Year From Date tsstfed l the work h0rein App lication is hereby made to the San Joaquin local Health District for orrice permit to construct an a existing Rules described. Regulations: described. This application is de in compliance with County ------- .. ��fl.�4.--------•... ...... . . ....CENSUS TRACE I JOB ADDRESS/LOCATION`--- ---- -- •-- - Phone -••----- .--•---... :.. :...--•----•-- �j � 1 Owner's Name �r_'� ......_.._ _. •-_.... ... ...City ---------- ------ Address c,C _f7�>3- Phone �� 9:.----...License i!�" . . -..t-• - Contractor s Name , .. Ey.�`iS�-•• Installation will serve: Residence CyApartment House Commercial EQTraller Court Q Motel Q Other ........................--------........ Number of bedroo Garbage Grinder Lot Size -------------------- ms Number of living units:_... . ------ :...................................Private Water Supply: Public System and name ...............••-••-•----------•--- - •- Cta Peat Q Sandy Loam Q Gay Loam' Character of soil to a depth of 3 feet: Sand'' Silt❑ Y {� ' Adobe Fill Waterial .,.If yes,type.............I. ......... Hardpan 0 - i ' (Plot .plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) 4 sewer is available within 200 feet NEW INSTALLATION: ` (No septic tank or seepage pit permitted if public ..................... . " .. Uquid Depth .--•--•-•....:....... PACKAGE TREATMENT ..... SEPTIC TANK I 1 Size............................................... ( ] Compartments Capacity ---------------•.... Type ---. Materia!.:..._ No: Compo ..--•--•.............. 9 Distance to nearest: Well .Foundation --- Prop. Line ............. - S No. of Lines ------------------------ Length of each line. ----. - .................Total Leg .•..... ----••-------- - Length .. LEACHING LINE [ G ' 'D' Box .- Type Filter Material .-.-...Depth Filter Material ................. --- k ., Distance to nearest: Welt ._.......... •- Foundation ---------- ------------- Property Line ....................... SEEPAGE PIT --. Rack filled Yes Q No Number .__:..----- [ 1 ' Depth -------. Diameter -...,----•---- ..Rock Size ................. Water Table Depth •--�----•--•--- Distance to nearest: Well ....................................... .Foundation ....-----•-- .. Pro Line REPAIR/ADDITION(Prev. Sanitation Permit f ..•---• -------------------------- Date p, --•-••-- -••--1 cam„ Septic Tank (Specify Requirements) _ Zf Disposl Field (Specify Require , _ �- -•------ � = [--x�•- .W . ••....... i . .:, i wNh San J _---- ----- -------------- ---------- -------------------- ._...__._... � (Draw existing and required addition on reverse§idel I hereby certify that I have prepared this application cind that the work will be done n acro ante oaquIn Regulations,of the San Joaquin local Health,91strict. Horne owner or IIRan- County Ordinances, State Laws, and Rules and sed agents signature certifies the following: p I arson in such manner "t certify that in the ormance of the wor for"which this permit is issued, 1 shall not employ any p as to beco esu a arkman Cornpe alien la s- f California." Signed _.:_ _� . -• - - - --- --------•---- -- ....: - - ------ -- --- :_. Title t ----- Y . :...... ..... {If other than owner}...._ .-._ , FOR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED BY. =.- DATE -- --- BUILDING PERMIT ISSUED --------- ----- = :. - -z................ ------- --- ADDITIONAL COMMENTS r .. _• - _.. _... _-- } - •-- 1- -------------------------------------------------- -------- ------------ ------------------ . ._. Date .. Final Inspection by: ..-..-.-._..--. .-- ----------------------- 8/7h 3M EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL Hi ALT DISTRICT t