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..sem FOR OFFICE USE: 4 ---APPLICATION FOR SANITATION PERMIT Permit No: _.7 Z:--G-- ti -----==------- ------- ------ ------ --_.-.,,.�:--------- I (Complete in Triplicate) --------------------- --------------- p Date issued ._.----------------- --------- Z ' This permit Expires 1 Year From Date issued5 ---------------- --------------------------------- ind e work er it to Application is hereby made to the San Joaquin lol Health lth Di triceordform Nom5Q9 and existing 9 RulestalndhRegulatonsrein � described. This application is made in compliance - CENSUS TRACT _s- -7 -� i JOB ADDRESS/LOCATION .__.�_ ��-�!_ P '-"""`�'.' ' t'" �:�'"-�--" ......r` - ---Phone ------ ------- --------------------- Owner's Name -- -------- ----------•----- -�-- - ----- City ---- ___ __�____._-- __ _ 4 r __ Address --- ----= � 417 Contractor's Name ----------- ----- ------ -- ---------------- --.License #�CR2L�----- Phone - IResidence ❑ Apartment House❑ Commercial:❑Trailer Court 'E:1Installation will serve: Motel ❑ Other -------------------------------------------- Number of living units:_-- -------- Number of bedrooms -�-----Garbage Grinder ------------ Lot Size --- ----i -- • ' -----"___--Private - - -------------------------------------- ------------------------- -- -- Water Supply: Public System andname ------------------------ -- - Sand Laam • Clay Loam ❑ +.,'— T ilt Cla•`❑ Peat❑ Y Character of soil-to•a depth of 3 feet. Sand❑ , S: ,❑ Y --------- .:. - .'---Hardpan� -Adobe•' Fill Material ------.,:- -_If yes, type ---------------------- Z% __________ ____� .. - -. ±. �1 buildings, etc. must be placed on reverse side.) (Plot plan, sowing size of lot,: location of system in relation. to wells, ` NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �� r t t . - )( - -- - Liquid Depth p PACKAGE TREATMENT i I SEPTIC TANK' No. Compartments � Capacity Type = Material -- ---------- p r # I, --- Pro Line ---4r -- Distance to nearest: Well ______ --------------=--- ---Foundation ____�Q____-- --- p e r 20.0 I Length of each .line----�10-0_ Total Length LEACHING LINE No. of-Lines - - Depth Filter Material ___ - _._ 0111'D' Box;--- -- Type Filter Material g ---- fit, -- property Line ---------- o Distance to nearest: Well :-,-.6- Q:!T----Foundation`:"1----' p SEEPAGE PIT ('�Q Depth I__ -�-- Diameter _-% 3------ Number --------�-------�----- Rock Filled Yes N 0 --�, Woter+, ITable Depth __----------------------------------------------Rock Size _- -'--- � i 1 �Q:� "_ ._.__ Prop. Line •---------- Distance to nearest: Well __-____-------------------------------- Foundation t = ' Date ------------;----------- ---------) ) REPAIR/ADDITION(Prey. Sanitation Permit#,•#-------------------------------- r, 1 ________________________________________________ _-______.._.__ Septic Tank (Specify Requirements} ___________________. Disposal Field [Specify Requirements) ---- ---- - ----- ti\jam --------------------- --------------------- ---------- _r. ` _ t------------- ---- --------------- t (Draw existin and''required addition on reverse side) he wo I hereby certify that I have prh Son Joaquin epared this-application and that he San Joark wuin Local ill be �Health District.-pe in accordance ttowner or I cen- County Ordinances, State Law and"Rules and Regulations oft 9 sed agents signature certifies the Followings �....--a. , ' '` person in such manner "I certify that in the performance of the work for which,�this permit Is issued, t shall not employiany as to become-subject-to.Workman's Compensation laws of California." Owner Signed - ---------- ----------- ----- ---- Title - (1f of han owner) _- . _FOR DEPARTMENT.USI~_.ONLY . •'S -i --- DATE -�'----1-�----- -------------- ------ APPLICATION ACCEPTED BY --- -- ------------- - ---T ------ i t _ - DATE BUILDING PERMIT ISSUED _ j---=----------------------- = .1� Art.._ -- --- -------- cADDITIONAL COMMENTS _____ -r - ------------------- ----------- --------- ---------"--------Date --------------- R_ --`°�' ---------------- - --- - -------------------•---• - �- Final Inspection by: _ - - . --•---- - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT r u 0 1-'i= Rev. 5M � �