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log 7OFFICE : APPLICATION FOR SANITATION PERMIT Permit Na. _ % ----------------- IComplete in Triplicate}-- --- - ---------------- Da#e Issued4 ��"��___ _____ ---------- ThisPermit Expires 1 Year Prom Date ssue- -- ocal edith rict for a l the work Application is hereby made to the San Joaquin iance wiHh County a'Permit and existing Rules tand Regulations.. rein described. This application is made p y� .' ------- -- - -- - CENSUS S TRACT ------------------ ------- JOB ADDRESS/LOCATION .- - Phone ------------------------------------�i ---•------------------- Owner's. Name �? �- City �r �< f f6� --- --- - , ------=------------ Address''_`°h- :° - -- --- - - - _ --- ---- �--. . '� �-'. -------------------- License Phonef-`-- Contractor s Name --.- � installationv✓i�ll.serve:_ Residence%Apartment,House❑ Commercial ❑Trailer Court ❑ 'Motel ❑Other -- ---------------------------------------- // ,� ' -Garba e Grinder�E'-�`---- Lot Size �' _-X 1��---------------•--' Number of living units:----- Number of bedrooms �----- 9 ----_Private ❑ --------------------- Water Supply: Public System and name -----{,:� �� J, �� ' AIO"�`.-----a- Cla Peat❑ Sandy Loam ❑ Clay Loam ❑ Character of soil-to a depth of 3 feet: Sand'❑ silt❑ Y ❑�: ' ye ---------------------------- v 1 Hardpan ❑ ------------ es Adobe . Fill Material __------_ - If , type ells, buildings, etc. must be placed on reverse side.) { plan,Ian, showing size of lot, location of .system in relation to w ,t permitted if public sewer is available within 200 feefi,) r KAGE TREATMENT [ ] S PTIC TANK' p p ' NEW INSTALLATION.- (No septic tank or seepageY 5ize_e - • LiquiTDepth .1 ��--------------- PAC , Material-( '� "o! -'----- No. Compartments - ----------- Capacity/ TYpef _- Foundation -,/P------------- Prop. Line Distance to nearest: Well _-__ f # LEACHING LINE - No. of Lines -----A-------------- Length of each line__-?,, ---------- ------ Tota! Length ,_� ._�-----••----••--- f W. Q' Box Type Filter Materia! �- C,�bepth Filter Material 1 ---.------- -7--------- Foundation - �� ------------- Property Line s Distance to nearest: Well _-_'"''�- f� ---- Diameter s! Numberf, ------------ Rock Filled Yes,® No ❑ SEEPAGE PIT ((� Depth __A --- i Water 'fable Depth -_ �� Rock Size /.__� - s Distance to nearest: Well -_-.-�'"' ------------------------- REPAIR/ADDITION ----- - Foundation ----------- Prop.Prop. Line _Ila- ----••------ - --------------------- Date --------------•--------•---------- REPAIR/ADDITION(Prev. Sanitation ermt ------------ - -- ------- Septic Tank (Specify Requirements) ------------------------ ----------------------------------------------------` .s.. i. ------------------------------ ----------- --------------------------- ---------- Disposal Field (Specify Requirements -------- -- - ---------- -- -------- ---- - --- - ------- ----------------- (Draw existing and required addition on reverse side) I hereby certify that 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: :i "1 certify that in the performance of the work for which this permit is issued, t shall not employ any person in such manner as to become subiect to Workman's Compensation laws of California." Signed ----- --------------------------------------- - -- � - r Title -4 -- ----------- ------------------ Owner By ----------------------- ---- (if er than owner) FOR DEPARTMENT USE ONLY ' �11 �/ __ RATE ---._�--J-�-�---�-�----- --- APPLICATION ACCEPTED BY --------r'�---------- - DATE ------------------------------------------- --------------- ------------------------------- -- ------- ' BUILDING PERMIT ISSUED ' i - --------------- ------------------------------ AQDlTIONAL COMMENTS _ p� „ - ----- -------- -------- --- r- . ----------------------------------- I------ ----- ------- -------- ----- /- -------------- -------- ------- ------------------- ---- ------------ ---------- -- --- ----- ------------ -------------------- to -- - - ------ Final Inspection --- - - SAN JOAQUIN LOCAL HEALTH DISTRICT r ..,may r LJ A 1 I_, iQ RPV AM k 5 -