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APPLICATION FOR SANITATION P5R L_,. -. . (Complete in Triplicate) .Z //. ----- Date Is.ue- ............................................. This Permit Rxeires ' Year From Date Issues' -.=7'icuVcir ig nereby .. Z.._ ..:- -_.. .iOctuir LOQ.. `^.= c,i 7i rrir, .- 7er. `c zescribed_ This caolic-ion'is moxa in compliance^ `4 Count' Crpino ce NoMSz9 cmc ex:-it;nc Rules ,n^ JOB ADDRESS/LOG4ilON 4(/-S� L----- ... Ji,� ._........................CENSUS TRACT .......................... owner s %cme ............ , --- �. ..........--•.............. Phone _ �....-------, Add-esa ............... ._.... ....---....------------ City / ------------------------- Cor-recto-'S Na;ne ........_..... .... ....,%�......,.... ............ ...License . -�_(..1. ?hone . - --, Inst•ollation will serve: Re ipence_XApartment House L Commercial f Trailer Cour 1 Motel -Other -......................... ..........•._ Im ^funber of living units:. Nember-af-bedrooms. ._.. ...-.._Garbo a Grinder ........_._. Lot Size .---- C . Water Supply: Public Sysrem and name ........---•-----------r ........---..- .................................------.........Private Cnaracter of soil to`a•cieptG or 3 feet: Sand J Silt G Clay `i Peat O Sandy Loam 0 Clcy Loom 1 Hardpan 7`1 Adobe C rill Material -----------. If yes,type ---------------------- r (Plot plan, showing-vize of-lot.4ocati4"f system-ii relation to wells, buildings, etc. must be placed on reverse sine.) c NEW INSTALLATION: (No septic tank ores ep ge pit permitted if public sewer'is available within 200 feet,', ?ACKAGE TREATMENT SEPTIC TANK f j Size......,_--------------_............-r_,....___ liquid Depch .................. 1 Capacity ....-.............. Type .................... Material----._I............... No. Compartments ................. e Distance fo nearest: Well --.•................................Foundation ---._____.__...---_... Prop, Line ----------___-_.---- LEACHING LINE ['1 No. of Lines Length-of ead'r line=._—. .................. Total Length ................_........._. �( 'D' Box ..._....... Type Filter Material ....................Depth Filter Material .......................---------------_-_ C Distance -o nearost: Well ........................ Foundation .----------_------__--- Property line ........................ t SEEPAGE PIT I Depth .... ._. -,-•------- Diameter ...........--_-_ Number ...........�..... - Rode Filled Yes L-11 No � t C WaterTcble Depth --- -------------------------..................Rock Size ---•------------------------ Distance ro nearest: Well __-----------------------------Fovn6ation ------------..__ Prop. Line ---------- _r_.. REPAIR/ADDITION(Prev. Sanitation Permit# `........._.......-...........I.......... Date -------------.. -•-..--___-) \ Sevtic Tank (Specify Requirementsl ............... ----•---------•--------.-• ---------------------------------------------------------------..........—^....... ..,..._. C Disposal Field (Specify eeGuirementsl ----- -- __'--•-,�------------r-.-�:5.��1!r.�^�s'''_----�`�.`�'-------_.._....,....,.--......_ ..--•-•-••------•--•------••---•-----••-•-----•--...•. ......... - --•---. ._ • ,xQ.... _...............................•-••-••--•-•.... --......_,....,,,-•------•----------_.••-•----•--------------•---•---------------------•---•--•---- --------------------- --- (Draw existing and required addition on reverse sidel I hereby certiir that 1 have prepared this application and that the work will be done in accordance with. San Joaquin County Ordinances, State Laws, and Rules and itegulatiens of ?he ion Joaquin Local Health District. Herne owner or Rcen- sod agents signature certifies the following: cortify that in file performance of Ph* work for which this permit is issued, 1 spall not empior any Parson in such »sonnet as to become subioct to Workman's Compensation laws of California." Sienec Q' _..... .�_S.P__Q�lZ .. Owner 4FI- 9t' ......... . "itle ....~1 ....................... .,..........------•--------- I` other Inar, owner) FOR DEPARTMENT USE GNLY TED "c _ .-.. On~ j� !,. ......... ................ . .................................DATA .........----- .....-.f .._. ..-._.._.. AC: -?CNAL COMmENTS . .. ..........................................._. _..... -----........_....... ....................... ........,.--------•--..._....... .......... .... . :. ... . . . ... ..... .. .. . . . I................ ......... •--- ............._... ------. ...................... ................... ..... .... .......... ___..,... � .. ' ._..... _.....,...... ......... _... . - _ D =7- SAN !CAG'.:IN LSC+i. i-%EALTH DISTRIC7 I- 63 :Rev. SM.