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FOR OFFICE USJAPPLICATION FOR SANITATION PERMIT Permit No- - ---------- ------- ' --�--- ---�:---- ------ ----•- - (Complete in Triplicate) - Date Issued---------- --- ------------ This Permit Expires 1 Year Fram Date Issue------- al alth rict for a l the work herein Application is hereby made to the San Joaquin cwitheCountytOrd Ordinance a permit and existing Rules tand Regulations: described. This application is made in / . - CENSUS TRACT --------- ------ JOB ADDRESS/LOCATION _11_Xr+--------� T------------------ ------ -- Phone�Y6+�"` c�----------- Owner's Name --------•-.-•---- -------- City Address p��15� - ,!f Phone v --a-' Name -- -�-�� /�• i-��------�� -��`-'-------License #.� --- -- --- ---•- Contractor's Na � -- --� i Installation will serve: ResidencegApartment House❑ Commercial ❑Tra9ler Court Cl Motel ❑Other -------------- ----------------------------- - -Garbo a Grinder .___-_- -- Lot Size _��X�,S �--------------•-- 1 ----------------------------- e -of living units:_._-- Number of bedrooms __ _ -� 9 _ e ❑ W-/�-/G-_tom------ ------- ----•-- ----- -- - - - -- --- Water Supply: Public System and name --- ^-'A-'---- Cla Loarn Character of sail to a depth of 3 feet:.. --Sand`❑ Silt 0 •Clay ❑ —Peat F1 Sandy Loam ❑_- Y ❑ ; Hardpan ElAdobe' Fill Material -------- --- I Yes,type -------- --- f• s _ ` [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. m ust be placed on reverse side.) - ! ermined if public sewer is available within 200 feet,) NEW INSTALLATION: It {No septic tank or seepage�� iit p Size Liquid Depth -----------------=-------- PACKAGE TREATMENT [ I SEPTIC TANK[ ] 6 _- No. Compartments ------ Material--------------------- 1 Capacity - ---------- T Distance to nearest: «Well --------------------- --- - --Foundation ---------------------- Prop. Line ---------- ------ LEACkING LINE [ ] No. of Lines ' `Length of each line--------------------- ------ Total Length �-De th f=ilter Material --------------- - ! i 'D' Box ------------ Type' Filter Materia{ t--------------- P Distance to nearest: Well _---"=-''"'='"-""''----- Foundation __----�`__-- --- - -,t Property Line. ------------------------ Number ------------- Depth ``r ` Rock Filled Yes ❑ No �❑ DiameterSEEPAGE PIT [ ] -Rock Size ------ Water Table Depth =------- -- ------------------------ • I Foundation -------------------- Prop. Line ----------------- ---- Distance to nearest: Well -------- I REPAIR/ADDITION(Prev. Sanitation Permit# -. �-_-_--� ; ------------------ -------------------------------------------------------- _ Septic Tank [Specify Requirements) ------------------ - e� Disposal Field (Specify-Requirements) I�-S _ - ,�cse�r----- y 4 {brow 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 Rul.es,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 work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Owner ---- f - ' Title -.. -- - � 8y f other than owner) 1 R MENT USE ONLY i DATE "/y--- APPLICATION ACCEPTED BY ------- -� DATE ------- --- ------------------------------- 4 BUILDING PERMIT ISSUED ------.---- ��-- . -- ---- ------- --------------------- ------- ADDITIONAL COMMENTS -- - --- - - ' - ---------------- ------------- ------------------------------------------ ---------------- - --------------------------------------- - ---------------------------------------------- Date - - ._ _ ---------- --- Final Inspection by- --------- E� -- - ------------------------------- � AN JOAQUIN LOCAL HEALTH DISTRICT