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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit yNo7� --------- FOR . ..T, Tripliia a}: .. �. .._ 7." ,�-- � gComDate issued _�--J6{ - -------- ----- -- -------------------------- -# --- This Permit Expires 1 Year From bate Issued t --- . or a A l'ication is herebymade to the San Joaquin Local Health DistOrdifr>ance NomS -- ----- District ------------------------ -to construct and install the work herein q 49 and existing Rules and Regulations: described. This applicationk is made in compliance with County t 11 s 5_. _ .; -----:----CENSUS TRACT -------------- `, - — -----------. JOB ADDRESS/LOCATION t._._,.- i •,, 1 -.- �� .; � -,: ------- - -------- ------- Phone3 z Owner's Name - �...;-'- 'fr r -•--- } �- + /.4(-------------------------------- ---------- City -T i Address '� Phone -- License # 7 ~ I. contractor's Name _ f/ i 4 / i Installation will serve: I Residence Apar invent House❑ Commercial :[ Trailei Court .❑ r t Motel ❑ Other -------------------------------------------- I ' = Number of living units:...... --- Number of bedrooms --- ----_-Garbage Grinder ______ Lot Size -- -- -{-- I -----,--- y Private ------ 11 Water Supply: Public System and .name ____-------------s-t Peat . Sand Loam -��Clay Loam 'E] I 1 Y "' I Character of soil to a depth of 3 feet: Sand'❑ Silt❑ C1ay ❑ _Yy� ❑ s,type � , H`ardpan []Adobe[I Fill`Materlaf ------ if Ye = l € # i in relation to wells, buildings, etc. must_ble placed on reverse !side.) (Pl'ot I plan, shows g-size o lot, location of system : 1 p seepage pit permitted.if public sewer is available Within 200 feet,) NEWINSTALLATION• (No se tic tank or f ,� ,� iLi uid Depth _---- -- PACKAGE TREATMENT [ J� SEPTIC TANK [ I �_. `Size-----------------= q p . .N �. rye�. o. Compartments _ Capacity l.2i6-Zi------- Type ' Material--- -- -- -- 3 r .... Foundation ---------- Prop. Line D11tance to nearest: Well - j Total Length :----- � `�-- N�.�.of„Lines�_,__-----_�-.---- .---- Length of each line______ ----- LEAC;HING LINE [ ] ' D' Box _ i --- Type Filter Material ____ -- -----Depth Filter Material -------J-��--•--•------- ----- Pro er Line ---��-------- Distance to nearest: Well ______3?' --------- Foundation �---- p I ,'- . Diameter x=h-- Number --------` Rock Filled Yes No , SEEPAGE PIT [�' Depth Y�'------- - --Rock Size -------------------------------- Distance ----------------------- - �. Water Table Depth ------------------------------------------------ --- ------- ------------------------------•- - Distance to nearest: Well -------------------•---- ----------------Foundation -------------------- Prop. Line ------ } - Date --------------- --•-------•---•-- F REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------- -------- ----- ------ -- Septic Tank (Specify Requirements) _____________________ (Specify Re uirements) ------------- --------------- ,: Disposal Field (Sp Y q ---------•----- • ------ -------- ----•`--------- k --------------- ----------------------------------------------------------------------- ----------------------------------- - --------------------- ---- ----------- --- --- e - ---------------------------------------- ------------------------------------------------ I - (Draw existing and required addition on reverse side) _ _ 1 her by certi y th to 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 licen- sed agents signature certifies the following: 111 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner t as Wbecome subject to Workman's Compensation laws of California." , Owner. Signed -------- --- -----------------------------.----------- ----- --- --- t i _______________ toff_ - -------- ------ Title - -------- ------- -------- ------- ------- - (If other than owner) F R D R MENT USE ONLY DATE .- �� APPLICATION ACCEPTED BY -,______- -- --- --= -- -- ---- - ----------- DATE --z -------- BUILDING PERMIT ISSUED --------------------- ----------- -- ----------------- 1 ADDITIONAL COMMENTS ---------------------- ---------------------- ' ----- ----------------------------------------------------------------------------------------- ------------------------------------- ------------------------------ : ------------------------------------------------------ ---------------- - Date i FinaNns ection b r SAN JOAQUIN LOCAL HEALTH DISTRICT f E. H. 9 1-'68 Rev. 5M