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FOR OFF CE USE: PLICATION FOR SANITATION PERMIT rfl Permit No. ------------------------- (Complete in Triplicate) --------------------------- -------------- Date Issued ---` . This Permit Expires 1 Year From ate issued -- --------------------------- --- - ----- ----- struct and e work herein ealth rict for a Application is hereby made to the San Joaquin jian compal liance County tOrd Hance permit and existing Rules tand hRegulat onst described. This application is made in p f,. r � 7 / -_._.--.-_CENSUS TRACT -"-*III JOB ADDRESS/LOCATION ---� :3------ "° - ' 7 i �^ ------- --Phone ------------ ---------------------- Owner's -------------- ------ Owner's Name . f ----- �. ! � ! -- -�-.' - ----- Address ---- - City ` ` � �• ? --------License # � `� Phone"Wur- �2 e ' - .A Contractor's Name -_- Installation will serve: Residence Apartment House'❑ Commercial :❑Trailer Court l❑ i Motel F] Other -------- ---- ------------ --------------- - Ga ba a Grinder _lC_ Lot Size Number of living units:--- -_ -- Number of bedrooms .a;- -- g r ' . ° Private ❑ Water Supply: Public System and name --__-------- -1- --- ❑ Y Clay Loam f Character of soil to a depth of 3 feet: Sand'❑ Silt❑ k Clay ❑ Peat Sand Loam 0 Y ❑ Hardpan ❑ Adobe XFill Material ------------ if yes,type - -- ------ ------- -- g size�of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (Plot plan, showin is available within 2 NEW INSTALLATION: . (No septic tank or seepage pit permitted if public sewer D - '� ------ -- -- ------ ------ Liquid Deptthh ---- --------------------- \ PACKAGE TREATMENT { ] SEPTIC TANK [ ] Size__________-__-___ - ---- Material---------------------- No, Compartments ----------- z 'r . Capacity ------------- ------ Type --------r i" Distance to nearest: We1i -----------------------------------•Foundation ---------------------- Prop. Line --------- tance to of Lines ------------------------ Length of each line-------------------- -------------------- ------------ - ----- Total Length ------- LEACHING LINE [ ] - _Depth Filter Material y D' Box --------- -- Type Filter Matgrial ------------- - YP --- - Property Line. - ---------------•=---- ` e Distance to nearest: Wel! ----_ -It -------- Foundation Foundation P Yy. Number -- ------- Rock Filled yes ❑ No I Depth --- ----- Diameter --------------- SEEPAGE PIT L ] P Water Table Depth ----------------------------------------------- -----�- :-.-:------:�.�;,� --- Rock Size . Distance to.nearest: Well ------------ -- -----Foundation --- Prop. Line.---------------------- !: ;Date ----------------------j REPAIR/ADDITION(Prev. tSanitation.Permit# -------•-- -- -- _ . ---- .rr ,quirementsj' -4 Septic Tank (Specify R �• . e Disposal Field (Specify Requirements) ---A--------------------------------------------i------------- _ = � V1__ ' ------�---- `�'o -- --=-y`------------ --------------- -------------------------- �_ -------=-------- ------------------------------------------------------------------- ------------------------------------ ------------------- f � (Draw existing and required addition;on reverse side) F I hereby certify that ilj hal pl pared this a6lication and that the work will be done in accordance with San Joaquin r ces, State,t uw , andti Rules nd Regulations _ of the San Joaquin Local Health District. Home owner or licen- County Ordinansed agents signature ce iffles Ahefollbw'14ang. _ person in such manner "I certify that in the perf_brmantre of the work for which this permit is issued, I shall not employ any Ts to become subject to Workr#rtdn's mpen ation laws of California." t j 3'gned - *TN -_ '7----- ) Owner B #_ - -------- ------- --------------- ------- ----- -� I - {lf o#h an'o neM FOR DEPARTMENT USE ONLY +� ------------- DATE iAPPLICATION ACCEPTED By -_ ------- ---- - -------- ---- -------- ---------------------------------------DATE ------------------------------------------- -!BUILDING PERMIT ISSUED -_ -_ ADDITIONAL COMMENTS - ----- ---- ------------------- I-------------- ------------------------------------------------------- ----------- ----------'.,- A------------� --------------------------------------------- ---- ----- -------- -.----------------I------------- ----- --- ------- tDate' s - - -------- --------------------- --------------------- --- 4 r Final Inspection by: -- - - ---------------Y-,-------e---- - --- - SAN JOAQUIN_.LOCAL HEALTH DISTRICT- E. H. 9 1-'6$ Rev. aM. �-� r�. `•�`a'� �'; `,,� ��. •-.,�. _ ; �.,. • -� `'y