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%JrrTkC MCI y, --- APPLICATION FOR SANITATION PERMIT _ ICornptate in Triplicate) Permit No. ..................... .... This Permit Expires 1 Year From Date Issued Date Issued :7s Application Is hereby made to the San Joaquin Local Health District for a permit to constant and Install thework herein 'described. This application Is made In compliance with County ordinance No. Sag and existing Rules and Regulations, JOB ADDRESS/LOCATION 1 ..-... ... ...... .......................�J... ...:.:.... .......CENSUS TRACT Owner's Name ....... Address . .... 'a• �' .City ' - Contractor's Name .. :.,...... ................. Cleanse t ................._ phone .............................. Installation will serves Residenceo Apartment House Commercial f]Trailer Court 0 -Mote!❑Other...................................... .• -- 1... - . Number of living units:..._........ Number of bedrooms ...Y.....Garbage Grinder Lot Size . Water Supply: Public System and name ................... .•----.._......_._...........,. U ..,.. ...................................................Private Character of soil to a depth of 3 feats Sand 0 Silt❑ Clay ® Peat❑ Sandy Loam) Clay Loam Hardpan❑ Adobe❑_ Fill Material.. ..... If yes,type .. ......... . {Plot plan, showing size of lot, location of system In -relation to wells, buildings, etc, must be placed an reverse side.) NEW INSTALLATIONS (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENTSEPTIC TANK ] �' I � Size..�.......................................... Liquid Depth ......... Capacity A........... Material..6'"........ No. Compartments ...1.4............ Distance 'to nearest: Well ._...1 . ........................Foundation.... �........... Prop. Line SJ ..0 TEACHING LINE No. of Lines ..--- ................ Length of each line......�.�f............ Total Length ........ 00 'D' Box t!`'"'--. Type Filter Material ..: .t"......Depth Filter Material g Distance to nearest[ Well .� '...:.:...:: Foundation - . :1f".":d................ Property .Line,..:....... -. Depth Diameter � -t l O. Number ....... .............(......-..z..�.... R..o..c..k...F..i.l.l.e.d Yesb No 0, Water Table Depth ......�~d.................................Rock Size . 1 , Distance to nearest: Well ............................Foundation ...f.6......... Prop. line ..ur......... REPAIR/ADDITION(Prey. Sanitation Permit# .......................................... Date .......... . . .} Septic Tank (Specify Requirements) .............................................. ..................................., .......................................__............. Disposal Field (Specify Requirements) .................................................................... ................_............ ................ .................................................................... ...................._.......................................:.................................................... (Draw existing and required addition on reverse side) x. 1 hereby certify that I hays prepared this application and that the worts will .be done In accordance with San Joaquin County Ordinances, Stole Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the worts for which this permit Is Issued, I shall not employ any person In such manner as to,becom`e uh(e Signed t to Wor ait om `an-satW -lows of-of d 9 �.rx-.... ..................................................... Owner BY .................................................. ..........----.. Jltle (If other than owner) + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..- ......... .... ...............................................---..... DATE . `. -. . ;�.......... BUILDING PERMIT ISSUED .................................................................. .DATE> ---- ADDIT IONAL COMMENTS ....... . .................... - ..... .................................................................... . ............. ..........---••---......-- ..-----........... ......... ... . ......../ Final Inspection by: ...... . :..... ✓y. ...._ ................Date _........ ER 13 2h 1-60 Rov. 53i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M