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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ....................... (Compleft in Triplicate) p Date-issued ............. ...................... _...._..... This Permit Expires 1 Year From Date slue Application is hereby made to the San Joaquin Local Health DistrictOnarnce Nom5�49 and existing Rulesinstall and ReguCat onsre+n App application +s made in compliance with Y described. This app ....CENSUS TRACT JOB ADDRESS/LOCATION . ..._. Sy—......Phon................................................ ........ . ... ........ 7 7 � .............. Owner's Name City -- 7 X ... ... � Phone�License #Address Contractor's Name ------•. . ................•--- .. -Apartment.House❑ Commercial ❑Trailer Court ❑ Residency Installation will serve: � Motel [].Other _..-.---•-•---- ............................. S l } -Y Garbage Grinder _...--- Lot Size ........ ......... Number of living units:__.--- Number of bedroom _.. ..__-.. Private ❑ Water Supply: Public System and WarnI.e.......................• peat E] Sandy Loom 0 Clay Loam Character of soil to a depth of 3 feet:' Sand b Silt C3Clay (3 Hardpan ❑ Adobe ❑ Fill Material ----••----•• If yes,type .............:........ buildings, etc. must be placed on reverse side.) f {Plot plan, showing size of lot, location .of. system in relation to wells, +t ermitted if public sewer is available within 204 feet) NEW INSTALLATION: (No septic tank or seepage p' p � � . Liquid Depth ... ................ SEPTIC TANK "O. . �----•...................•-... . � k PACKAGE TREATMENT [ ] No. Compartments 6 �1 Type _ .. Material. G �_... Capacity� I -•• / r (� �-� Prop. Line . .. " .Foundation ... ---• •---...-----•-� .. .._...-•---- DlStanCE to nearest- 'Well ....................•---•-.......-. g. r r k .--C�..S_..._ . Total Length ....�.. -�.....•........ N �/.-----•--- Length of ach line._ + LEACHING LINE No. of Lines -...•. .....Depth Filter Material __....1. D`YBox :.... Type Filter Material .. _. .. ... �} - I Line Foundation ... /�j-,--7.'-:.._. Property Distance to neaes#: Well .......•-•---r•• Rock Filled Yes No ❑ + . (. ...._ Number SEEPAGE PIT [ ] '1 �Depth. .`...�.� : _. Diameter I � .-.. ..... � � .:Rock Size . �- /D"- - p,R�gleV S Water Table Depth, ' U ,5t4 jq P p --------------------------------- - •-•/.4..-f:. Prop. Line -- ---------------- F .....-.Foundation Distance to nearest:.Well tate --- ------ -----•-•--•--•--- 1 REPAIR/ADDITION(Prev. Sanitation Permit�# ....----•---__.._--__ r Septic Tank lSpecify Requiremenfsl ..-----.. ................ -•-•--•--•--... .........•• - Disposal Field (Specify Requirements) .............•- ........................................... ..............•......._..._.. -----••---•--••..............•--- ................. ...................... -- -- {Draw eicisting acid required addition on reverse side) .. f I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules-and Regulations of the San Joaquin Local Health District. Home owner. or {{ten- sed agents signature certifies the following: permit is issued. 1 shall not employ any person in such manner "I certify that in the performance of the work for which this p _r as to become subject'to Woikman`s Compensation'l'aws`Of California.", - Owner Signed :�._._.._. .......................•-•-......, Title __........._. i (if other th wrier) FOR DEPARTMENT USE ONLY / .. DATE .._•--- ...`�1. _ •.:...--•........................... DATE ..........:..:..__:_... APPLICATION ACCEPTED BY .._... .... �. r r .'............. BUILDING PERMIT ISSUED = = ;....-•-- r. r ADDITIONAL COMMENTS ---••---•--- ......----• ......... • ._.... ..._...-•-•••--••-•......... .......................••---._.....__.. ............... --•---..... . ... - + .......Date ""' •�7J` Final Inspection by: .:...__..••--..._ y x SAN..JOAQUIN LOCAL HEALTH DISTRICT . . � � 1 .2 96 . — .,- cu -