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FOR OFFICE USE: _ �AppL'IGATION!FOR SANITATIONy.PERMIT permit No ._-- ---- [' FOR OF ICE USE: 7 7 --------------------- ��F�~ [Camp lete in Triplicate) Date issued_�-o��--77 -'-- - - ----- - - --- - This Per Expires 1 Year From Date issued -••------------ San Joaquin Local Health District for a perrrrit to construct and install the work herein describe 4 Application is hereby made to the .�. .� -- lication is made in compliance with County Ordinance and existing Rules and Regu at+ons: This app - p CENSUS TRACT ------------=--------- .� --- -------- ------- 4 1 r o �� JOB ADDRESS/LO�P, N_._--,. . '�- ---------- F Phone � - - Owner's Name.' City"�" ` ..- -- ,�/ -- --- - Address._-- License #-- ---- ; } �--` . /p,part ------------- ment House❑ Commercial ❑ ..:. .�❑ Contractors Name_._ [�" Residence Installation'w+ll serve: , ---------- Trailer Court Motel ❑ Other _ .. s.. .._. : t ------ Lot'Size._:_ _==Garbage Grinder_-'---- ---- ; N ber.of.liv.ing units:.___- ------Number of bedrooms private ' ---------=---------- --:- --. , Water Supply: Public System and name__--,------,`-- peat ❑ Sandy Loam ❑ Clay Loam ❑ t -Cloy C . E y e Character of soil to a depth of 3 feet: Sand ❑ . Silt a e ial-- -_-------1f es, type-- Hardpan ❑ `Adobe "Fill i size of lot, location of system in relation to'.wells, buildings,'etc. must be placed on reverse side.} F (plot plan, showing f i +t erm+tied if ublic sewer is available within 200 feet,} } NEW INSTALLATIONi (No=septic tank or epage ;p p , p. r ! Liquid Depth---------------- + 7 / SEPTIC TANK` [dl" Size -4- -� " ...- t PACKAGE TREATMENT"['"]" -------- v'o-Compartments_------- ` ------- _ 4T e�11 - .- Material.t� Capacity/ U= Yp r +Foundation..` - - - ,.Prop. Line_.��-`� ' Length of each.li -� I I + Distance' Q U �. to nearest: Well = 3 ------; _ _,Total' Length - -- _ -- n s {r LINE: _.[�No_.Qf Lrnes_--- `.: � ®._ r i r QC ept�"i Filter.;Material------------------- LEACHING i : r-f D' Box.-----------Type Filter Mater+al_5�---_ - ---- ine-- �[ , .. .. be ------------ Depth.- - - s _ Rock F+ll N C :Distance to rieares# Well-; �� Fund_ ati n GG' r--_ P�operty / - - ; Al L r . ,.ti...... .._ . -- --- �--Num c � 7 �. R De th--��- �- -Diameter--- �- . .I� - e SEEPAGE PIT E p. r c az __ --- --------------------------- r �— i... - k S' e Water Table Depth = -°----- ---- Ro 1 ---- iFoundotibn-_ 1/�_ a'-------'-.Prop. Line-.5-7 - --------- " Distance to nearest: i pate -------- -- -------------- } REPAIR/ADDITION (Prev..Sanitation Permit#- __:=- =------- , - I _j-1 t ----- -------------------------------- .. . f, Septic Tank (Specify Requirements)--------------- ---i-- ----- ----------------------------------- iLi 1?n. ---- - =--------------------------- • ------------------------- --- ---=�1_'_-�-"-------------- Disposal Field-(Specify Requirements} `, - -- - - ------- -. --------- - _ i -- -------------------- f -- _-.-- 1 --------- -'------------- -------------------------- -------------- (Draw existing and required addition on reverse... sidef x I hereby certify that I have prepared this app lication and that the work will be done int accordance with San Joaquin Coun Rules and Regulations of Ordinances, State. Laws, and the San Joaquin Local Health District, Home owner or licensed ager signature certifies the following i ' `^ 10 tiny person in such manner "I certify that in the performance of the work for which this permit is issued, I shall notemp y to become ec, to Wo man' . Compensgih'o++. laws of California." 1 i = ------- Owner -- -- -:-- _ }, ------------ - Sign{ed -s Title---...... B (If other than ow 'FOR DEP _t. �� •- ARTMEN7-USE ONLY rDATE. 7` -----------=------- ---------------- --------- - ------- APPLICATION ACCEPTED. BY-'---- - -- -. -- ;_n .DA'TE �------ ----------=----------- DIVISION OF LAND NUMBER --_----------------- -- -----------