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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� !4 Y� • Permit No. ..................:.. ' ...................................I—:------------•- )Complete in Triplicate) ............................•--....--... ............... Date issued �........:........ ....•........ ............I..........I........._..... This Permit Expires 1 Year From Date Issued Application 's hereby made to the San Joaquin Local Health District for a permit to corrc o in t �t rk herein described. This application is d in compliance with County�Oj rdinance No. 544 and ex s i gn ale i�J eg IatioRs: r JOi3 ADDRESS/L T N . - ! .. �'....1 ........................: CENSUS`TRACT ..-....................... F: _. �. ,- . .::.......: . ...:....... .._...Phone Owner's Name a.- •-• ;1 ....City..................... .. Address • .......... . .... �. .c Phone i " .: .License ,�` • .. .. Contractor's Name ... Installation will serve: Residence partment House fl Commercial❑Trailer Court O Mote ❑Other .....................:....................... �T a i p .Garbo a Grinder Lot Size Number a�Iiv[ng units:...-..�_-_, Number of bediaoms :...�.._.. g ••••••••"••• ' Water Supply: Public System and name . ......... ............. ... ............7......... . Ci _. ._oa Iva [1}� Pr to Character of soil to a depth of 3 feet: Sand ❑ .Slit❑ Clay ❑ -Peat❑ Sandy loam ay L m ❑ +� I Hardpan ❑ Adobe 0 Fi}I Material :.....__....if yes,type -------------•-•--......•... t (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc, must be placed on reverse side.) i ' 3 NEIN INSTALLATIONS (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) ` - I PACKAGE TREATMENT I ] SEPTIC TANK( Size*.. ..................••.............. Liquid Depth .............................. . Cnpacity .................... Type ................. Material-----"-•.............. No. Compartments ...:...... .......:.... F datio Prop. Ina ............... i Distance to nearest: Well .....:.....:.......................noun .. n; i Total len th S ..__.. LEACHING LINE I ] No, of Eines_-....----•=:-:'_•-:"Teri of each ane..---•...._.......,_.... D' Box :. Type'Filter Mttiter3tti Depth Filter Material ..........................................•- Distance to�nearesh 1Nell I . Foundation ............................ Property line ........................ �` "''4 1 k Filled a • . ..._.......Number �. Si<EP� AGE P17 ( 1 Depth Diameter .... .......................... R.oc ....--- 'I es -•----•t e I ...RQek Size ' . . Water Table i7epth�--•-•------•---...,.., ....................t• . - r'� r i ..Foundation ......... Prop. line ...................... Distance to neate�itt:Weil ...._.... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------- ............ Dote _..•..... .............. _ Septic Tank (Specify Requirements) ••••• -----•-- ... -------- ------------ lk Disposal Field (specify Re�juirem nts) .._..._.... ----•- •--•- • ' fs l -t�. '--.- b • �`"'-~'i ..................•--...... ..-......---..........................._.._.. _ .............................................................. (Drawxistin and required addition on reverse side e 1 hereby terrify that I have prepared this application and that the work will be done in accordance with Son Joaquin i County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin loco! #fealth District. Home owner or lieen- sed agents.signature arson In such marmot "I certiFy that in the performance of the work for which this permit is issued, i shall not employ any p as to become subiect to Workman'srdwponsation laws ofCaliforniay' Signed ......................._..........-.... r ..........._.. Owner _xitle � .... ........... ...............•. r By ............................................. ..._... - (If other than owner) FOR.DEPARTMFeNT USE ONLY r . Jl� r .. ...................•• APPLICATION ACCEPTED BY ...:.._...I............................ DATE . ..•- .:.�. ....... .......... ..... ................. DATE BUILDING PERMIT ISSUED ADDITIONAL COMMENTS ......................I'll.........---•-•--.................._........._. ......•......................................:_...:................, ....................................._ ...........................__........._......... ..�.._-a.,�. .4.,I•......_........, .. ..-............................. a ..............Dote f .. C...... .7-_.----•-•-----...... :......................... Final Inspection by: _--•:-•;..i•- - ... ... .......... .. SAN JOAQUIN-LOCAL HEALTH DISTRICT 7/72 311 ` c u 13 '24 1.•A;t Rwv. 5M w