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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � Permit No. .-7'� ....7/ ------------ .#-----••-. .....-- •----.... (Cnmpiete in Triplicate) ��.... Date issued -. •�•- - � .......... This Permit Expires 1 Year From onto Issued . ............... ........... ............. .. .. . Rules and Regulations: ' hereby made to the San Joaquin Local Health DistrictOinance Permit and exstristing d install the work herein Application +s Y described. This application is made in compliance with County r CENSUS TRACT U .`-.. . _ r, ...... JOB ADDRESS/LOCATIN �t 111,J_ phone .. . r,.r,.�� Owner's Name .-.-. City -.._ �•-- 1� A.r" -... b L Address a2 Jc71. Phone f ... ..........- ............... # .._.. .- Contractor's Name .-✓..� ••�_ Trailer Court 1 Installation will serve: Residence ❑Apartment House❑ Commercial'❑ �+ Motel ❑Other:-...-.------------------------------------- Garbage Grinder .....-_...-. Lot Size Number of living units:...------- Number of bedrooms --- ------- / ............................_.. ... ...........Private ❑ Water Supply: Public System and name -.----• -- - Peat❑ y Clay Loam ❑ .Silt❑ Clay ❑ Sand Loam •❑ Character of soil to a depth-of 3 feet: Sand❑ .- Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type f. s stem in relation to wells, buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location o Y k d if NEW INSTALLATION: (No septic tank or seepage pit permitted public sewer is available within 200 feet, Liquid Depth .................... SEPTIC TANK J 3 Size-------------------------------------- p0 PACKAGE TREATMENT ( ] Compartments ...................... 0 � Capacity •-- Type --•---------------•. Material•----••----•---------• No. -Co p - Pro Line Foundation P• ...................... a - ••---•-•-------------- nearest: Well -----•-•-- ....... Distance to •-•-••-------".. ' Tota! Length .................... ` ( ) No. of Lines . length of each line--.-----•----•----••-..-..._ LEACHING LINE 1 'D' Box ------------ Type Filter Material ..................Depth Filter Materia •----•----- Property Line ........................ � Distance to nearest: Well ..................••.... Foundation -..--..•..------..-.---- No Number .-. - Rock Filled Yes ❑ -- Diameter - ----•----------•---••-- ) 7 Depth •----------• SEEPAGE PIT �'-'-""-- Rock Size ---•..._....---- ._......_ .............. Water Table Depth ----•------• ..Foundation .. Prop. '•-'••'- Distance to nearest: Well --.---- ........ -•-•••.........„••.. Line .. Date --••••........--•-) V ` REPAIR/ADDITION(Prev. Sanitation Permit# -• -• • a �� • . (� Septic Tank (Specify Requirements) .-...- . - -•---- ................................ -_---••---_-.... Vb i (Specify Requirements) -------------- pisposal Field 15p fY - ---••-----• o .................. ----••-.. --•--- ----------------------------------------------------------- ---------•-----' - ---- --•----------------(Draw-ex existing and required addition on reverse si e rk will 13,e ne in accordace Joaquin I hereby certify that I have prepared this application and that the the San°Joaquin LocaloHealth DistrictnNometh Son owner or I cen- Cnunty Ordinances, State Laws, and Rules and Regulations of I sed agents signature certifies the following- permit is issued, i shatl not employ any person in such manner t "I certify that in the performance of the work for which this as to become subject to Workman's Compensation taws of California.” i ___-•. Owner Signed ; ...••• ........ = . Title - By (I other than ow r) I OR DEPA167M NT USE ONLY DATE APPLICATION ACCEPTE=D BY ••-• • ..... .. .............. ........•--• ......... ..DATE _..............................------------ .---- -•.................• •-•----•-•-....•--- •-•-....................... ---•-- •..-_.I—— • ... BUILDING 'PERMIT' ISSUED..--.:'_. - •-•...............................•-- ......•----•--•---•-----•. •........................... ADDITIONAL COMMENTS ........... .........................i-..-�---•--...-..-....---•-- ............:....... .. ........... -- ...... ......... Date ... ?.'� ....................._. .. ------------ --• •...........Final Inspection lay: .. :--- - .. ............... SAN JOAQUIN -LOCAL HEALTH DISTRICT 7172 3 M