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FOR E)FFIC-E-DISE: APPLICATION FOR SANITATION PERMIT` - ' � Permit No. -- ----------------� `(Complete in Triplicate) i Date Issued ---16-�---��-------7--.z 1�. ' --------------------------------- This Permit Expires 1 Year from Date issued - alth t for a it to construct and l the work herein A plication is hereby made to the San Joaquin Loc withe County DtOrdinance d Hance Nom549 and existing Rules tand Regulations: described. This application is made in compliance ' CENSUS TRACT / . ' .106 ADDRESS/LOCATION, -- - L� ��:�`-7_�l��------ VZ -------------- - Phone - - o Owner's Name ----- -- - ---------------------------- O --- --------- -- —-------- i Address � = # License J, I/ Phone - ' � . Contractor's Name -. I Residence Installation will serve: $Apartment House❑ Commercial;❑Trailer Court Motel ❑Other - - --- ---------------------------------- 'a- ------------ ------------ ------- Lot Size i � Garbage Grinder - -_----- - - Number of living units:------ -- -- Number of bedrooms ---,�---- Private ❑ -- ea --------------- - Water Supply: Public System and name ---------------------------------Cl- `a----- ----- Pt❑ Sandy Loam C] Clay,Loam Character of soil to a depth of 3 feet: Sand'o Silt❑ Y � y e Hardpan ❑ Adobe Fill Material --_-- --_--- l es,type Hardpan N j ced on reverse side.) {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pla permitted if public sew is available within 200 feet) cr s NEW INSTALLATION: (No septic tank or seepage pit p Liquid Depth -- --- PACKAGE TREATMENT I I SEPTIC TANK No. Compartments ---------------- r i - '_-- Material- . Capacity a----- Type f �O - ----------------------Foundation ---1.4----------- Prop. Line ----------- ------- Distance ------Distance to nearest: Well ----------------------------------- ----------- - r -�► ............. i LEACHING LINE ] No. of Lines ----- -- �•--------- Length of eac line---_.--�"�----- ----- Total Length ,------ --- D' Box ---_. " -- Type Filter Material --_-_ --_---_Depth Filter Material -_--- - Foundation ----- --- Property Line_ -- ---------•-----•-- Distance to nearest: Well ------------------------ tEr �_-- --- Rock Filled Yes � No � SEEPAGE PIT � p _ Diameter -7- ----- Number .... r "�--- � rr --- -- - r Water Table Depth --_---- ------------------------------Rock Size }----- 2-S Distance to nearest: Well --------------------- --- --------------Foundation ----- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# --------- ------- - Septic Tank {Specify Requirements} _---__-_ ------------------------------------------------------------------------- ----------------------------------------------- - --------------------- Disposal Field {Specify Requirements) ---------- - ------------------------ -------------------------- -- - ---------------------------------------------------------------- ------------------------ - -------- ------------------------ (Draw 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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liten- i sed agents signature certifies the following: k for which this permit is issued, 1 shall not employ any person in such manner "I certify that in the performance of the war as to become subject to Workman's Compensation laws of California." Owner Signed ---------- ------------------- r - --------- ------------------------ Title - -------------------------- {I at han owner} R RTMENT NLY DATE ---- - ------------------- APPLICATION ACCEPTED B -- ------ --------------- BUILDING PERMIT ISSUED ----- ----------------------------- ADDITIONAL ----- - ---------------------------- ADDITIONAL COMMENTS ifT -----a�---- 7. ,^- --�---0--�-�a�c----------------------------------------------------------------------------------------------- ---- ------------------- --- _ --------------- ------ ------ ------------------------- -----Date ---- � --� 1 �--I-° - -- ----------- -------------------------- - - - --- --- ------------ ____ ---------------- Final inspection by: _ _- - ------ - -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT CA E. H. 9 1-'68 Rev. 5M -