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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT' :,..-r_•......:............................. Permit No. .. .' .� I (Complete in Triplicate) ........._.............................................f... ........................... 1I - This Permit Expires I Year From Date Issued Date Issued .... . .-. ..3 Application is hereby madel�to the San Joaquin Local Health District for a permit to construct and install the work herein described. This opplication " m=e in coal fiance ty Ord�nce�o �¢9 and exi Ing Rules and Regulations: y y ,v5c� ea��. fN, CENSUS TRACT JOB ADDRESS/LOOT O��i .._ :..V...-. -.. ...... .._ ,c...... --• --.Phone �.�.......... .. ....--.. Owners Name •-•--- .. .. ..... ........' _ " ....... Cft ..........I...... ........................................... Address ...........8,362... •r(fi(� ...... ..:. .......... y, �S`f- �`3. ` ��--......Q _.... Contractor's Name ......... ... ........_.._. ... --•• .. ....: License # .._..._..:. ..__ .. Phone Installation will serve: Residence .Apartment House❑ Commercial ❑Trailer Court ❑ � 1 Motel ❑Other .......................a............. ...... ; -:._ ' ...........: Nvmb�er-of•living•units:.:R ��:.��Number--of-bedrooms; ::�.:._.Garbage-Grincfer_.._.....__.._LattSize__T..�....... ........ Water Supply: Public System and name ...--•.................._.---.......----------._...._-----------.. _-_ ------....------------ .......Private` Character of soil to a depth of 3 feet: Sand ❑ Silt[] y Clay `[} Peof 0 Sandy Loam ❑ Clay Loam S.ti Hardpan Adobe :M ' Fill Material ............ If yes,type ............................ i I (Plot plan, showing size o lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) il NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( } SEPTIC TAN � Size-..-y�.?r.. . .......... ............... Liquid Depth ..... --...... ---•• -- E Cdpacity)� ...... Type _........ Material..�?'1��:' No. Compartments .. .............Foundation .. •................... Distance to nearest We Q .1®..t-� •-... Prop. Line ...�_r........�. t LEACHING LINE No. of Lines -----2............... length of each line_./:o......I....... Total Length Cl ..........�o 'Q'I'I --- Sox ......t�Type Filter Material :9 =,:--:Depth Filter Material ..�.�............. ............... r Distance to nearest: Well .. Q. ......::"Foundation ..�-0-.. ........ Property Line 5........�...---._.. st , SEEPAGE PIT Qepth. .. .---_-_-- Diameter . ..... tVumber_::._ .y.............. Rock Filled Yes No Q Water Table Depth .. Rock Size J15.. �'..' ..---•__-• it ...... Prop. . Distance to nearest: Well ..�a.0.,y`'.................. , Foundation /O :-!`•" o Line REPAIR/ADDITION(Prev. Sanitation Permit# ..............................__...... .... Date ...........................I....... Septic Tank (Specify Requirements} :..----•-------------- ---------------------- -•----•. ------••----. ........ - ....... - Disposal.Field (Specify. Requirements) ................-.............................................-----------._.. :... -- ---...._... ._ �. .................................................................................. °i� (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, aacl-Rules and Regulations of the San Joaquin Local Health District. Ho`nte owner or licen- sed agents signature certifies the following: _ .} "I certify that in the performance of the work for which this, permlt-is_issued, I shall not employ any porion in such manner -. �- - I as to become subject to Workman's Compensation laws of California." Si nod Owner y.-- BY ............. ... (If oth14c._. .. ....._........ Title .�. ... ............................ wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY ............•............................. .................. DATE.... ..." -" 3....'......--- BUILDING PERMIT ISSUED"`............... DATE ......................................_...... ADDITIONAL COMMENTS 1i4. i �l. ......... .................................. ......------................--- -•-.... -----.............._.........._. .......... b ........... .......... ................... . .......... _ - � .. - ... r .... ...........................................................................-..�. ._ •._ ....•.... ...... _ .'. ... ._._ _..y. i Final Inspection by: ........................ ate �..... . _ D ..._._.. SAN JOAQUIN LOCAL HEALTH' DISTRICT , i 7/72 3 M F_ 1q-13 24 i•'b8 Rev. 5M, '