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—FOR FOR OFFICE USE: �` gppLICATION FOR SANITATION PERMIT _ 3 Permit No. 7l- . 9 , (Complete in Triplicate) 0-5. 7 Date issued ------------- ---------- This Permit Expires 1 Year From ate issued z it tc; construct and Application is hereby made to the San Joaquin eLocal wi heCou alth pytOrdirnarict rn a NorS49 and exist ng Rules tand th Regulations.,work I described. This application is made in comp - / f �} r -CENSUS TRACT Jr =h - '",�y'' - -CT -------- JOB ADDRESS/LOCATION -__Phone- �-� d � ' --: Owner's Name ----. . G -City Address License # �- - --- -------------- Phone ----------------------- -- -- - - Contractor's Name - ------ 1- ---' urt Residence;M Apartment House❑ Commercial❑Trailer Co installation will serve: i❑ Motel•.❑ OtFier ------------------------------------------- Garbage Grinder ------ Lot Size -------- - Dry Number of living units:____.r"__._ Number of hedrooms "" - -- - Private �___-_x_r.. P ❑ Water Supply: Public System and name _.__ Clay Loam Character of soil to a depth of 3 feet: Sand'[]f Silt[] Clay ❑ Peat❑ Sandy Loam ❑ Y .� Hardpan E] Adobe Fill Material -------- --- 1 yes,type ---- ------- 11 {Phot plan, showing size of lot, location- of systern IJn relation to wells, buildings, etc. must be placed on reverse side.) VJ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK:[ ] Size----------------- ---------': ------ Liquid Depth x ...., '�-�-� No. compartments --------------- ------ 1 Capacity =------ -- -- Type - i-- --------- Material P s _ Foundation ----- ---------------- Prop. Line - F Distance .to nearest: Well -` i:. .' - .. _ Len t11-of�each line------------------ - ---- Total Length -----------------•------•-- LEACHING LINE [ ] No. of Lines ------------------- -- g _ _Deth Filter Material ----------------------------------------- -- 'D' Box ------ --- Type e Filter Material --------------=--- P r-r--- Distance to`nearest:-Wei l `�`---=-=----=--==- Foundation --------------- Property Line --------•------- Number Rock Filled Yes ❑ No ❑ ----- Diameter ----------------- I 'r SEEPAGE PIT [ ] � ��-..depth ----- ------- - s Water Table Depth -------------------------------------------- ---- ------ ---•--------------•----------------Rock Size --Foundation-------on ---------------------- ---- - -----p. £` l Pro Line ------------ -=-----•- Distance ' to nearest: Well --------------------------------------- --- - REPAIR/ADDITION(Prev. Sanitafiion ermi -------------------------------------------- Date -------------------- -------------) ------------------------- Septic Tank (Specify Requirements) -------- ? Disposal Field (S ecify Requirements) ____-,3D-------- N 1 "" "" "" ""--------- _A_ - � .---.------ 0 � -> -------------------------------- ired addition-` fro ,6 - S � (Draw existing and required addition n reverse side} wih Son Joaquin { hereby certify that { have prepared this application Ip} that of the Son Joaquin LocaloHe 1 h District.ance ometowner or Il ons County Ordinances, State Laws,land Rules and Reg i sed agents signature certifies thesfollowing: "1 certify that in the performance of the work for cws of California•+�ssued,:I shall not employ any person in such manner ! as to become subject to Workman+s Compensation E Owner Signed ------- 7 -------------- --------------- s. r �� _ -_ Title'----------- By -W_ ---- L S'J ------- -- - ---- ------ - - - --- - (If other than ovMerl FOR DEPARTMENT USE-ONLY f APPLICATION ACCEPTED BY __ _ ---/�L�._�/ �--Y DATE BUILDING PERMIT ISSUED ---- ------------------------------ --------- --------------- '------------- ------DATE ff- ---- ------------------------------------ - ----------------- ADDITIONAL COMMENTS "--------------------------- _. _ -------------- - .--.-.-. --------------------------------------------------------------------------------------------`- - --- --- --------------I-------------- --- "�---- -- ------------------------- ---.Date :-- =. . --=------- --- - - Final Inspection b '�-- = ------'---- 1,.1, ..�SAN JOAQUIN ALO A -HEALTH DISTRICT h � - 1 e u 0 1_'AR Rev. 5M _.