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FOR OFFICE USE. � �. � �~'. � APPLICATION FOR SANITATION PERMIT permit No. .6' s ...............•-•............... . .�•....._.._--.-.._ •.. •• (Complete in Triplicate i Date issued ...7 °.:. This Permit Expires 1 Year From Date issue Application is hereby made to the San Joaquin orn IlaLocal c c wHealthtu tDistrict rinance Nom549 and existing Rules described Regulations,herein truct and x 4 described. This application is made 'in ........ ,JOB ADDRESS/LOCATION �r ....CENSUS TRACT ----....__ . k Owner's Name ..- ._ .. . - .............•----• Phone it Address ._.. •-- ... City ..............••--•-•••--...... __. _.._ . ._ r�7► I .License #J.��_� -•-• Phone - r Contractor's Name ..... ••- •-- �7�� - ?. . ` installation will serve: Residence.A Apartment House f3 Commercial QTrailer Court fl Motel-j]Other ............................................ Number of living units:.--l..__..- Number of bead ms ---�-.-Garba e Grinder ..___...._.: tot Size .� / - M�s Private D \_ Water Supply: Public System and name'___- � r Silt Clay ❑ Peat Q Sandy Loam ❑ Clay Loam. 4 Character of soil to a depth of 3 feet: Sand.0 ❑ e ---------- •• -------- Hardpan C] Q Adobe. -Fill Material ..-.-....... if yes,type (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc, must'be placed on reverse side.) N, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is ilable within 200 feet,] ova SEPTIC TANK I ] Size... '....... ...............I------...• liquid Depth --.. PACKAGE TREATMENT [ ] •- No. Compartments Capacity .................... Type ---_-_------- i Foundation ..........:.:......... Prop. line --•--- .............. Distance to nearest: Well .................................... •------- -------------- Length of each line-__--..........__.--..._.... Total length ............................ LEACHING LINE [ ] No, of Lines - -.-----Depth Filter Material ....................------.............. :... n - 'D' Box .---.---•--- Type- Filter Material ---•.---•---- Distance to nearest- Well ---------............... Foundation ......................... Property Line ................ [ ) Depth 9.X191 ADiameter ................ Number ......I-------------_...._ Rock Filled Yes No (] -•—�--�" _.Rock Size - o ,.Water Table Depth •=----'---••- --•---• - Distance to nearest: We ••-•-••-•••--••---•----•--• Foundation Prop. Line _ REPAIR/ADDITION(Prev. Sanitation Permit ...• pate ........... ) _... Septic Tank (Specify.Requirements) _._ -••- ............... :---•-•-------•• -----• ........ . i Disposal Field .(Specify Requirements) .•...--�•• -----•--------_------•-_.............. w Y -------------------------•-----.r._._...._..._... -------- m ., {Drow existing and required addition on reverse side) � application and that the work will be done in accordance with San Joaquin .i hereby tertifya�iigt 4 have prepared this County Ordinan.:Ci'�i ; State Laws, and Rules and Regulations of the San Joaquin local Health District. home owner or licen- »'t4 " sed agents signnture.certifies the following: ermit is issued, I shall not employ any person in such manner `l certify that +n the-performance of the work for which this p �iCto become subject to Workman's.Compensation laws of California." d Owner ne ...•••'-• i ................... Title ----_------- -------------------- ----------•-•----- E (I other than owner) ' FOR DEPARTMENT USE ONLY .IJ�.c-✓ DATE . 7 _.�. ... .. .............. APPLICATION ACCEPTED 8Y """ ' ' PATE BUILDING PERMIT ISSUED ....................----- •. --•••-.•--- ADDITIONAL COMMENTS ""' ... ...... ....._.. ......... `........:..... .. Date ..__.... .... Final In by: ...... -• •• •• -"" -` -• SAN JOAQUIN LOCAL HEALTH DISTRICT - �" 7/723 14