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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ._...--•-•.......................•---••-•-•-...._..._..__ 1complete In Triplicatel ' yes �. :._._...... .............................. v Date Issued _4 ........... i This Permit Expires 1 Year From Date Issued ....................................................... istrict all herein Application is hereby made to the San Joaquin o l Health D Ordinance rpermit and existing Rules tand hRegulatons: described. This application is made in compliance •- r' . ' JOB ADDRESS/LOCATION .... .Q_Q--. ?.....__•y.---:--..C.,._...._... .....CENSUS TRACT Phone .,. ..� `. ±, . ... ._. Of Owner's Name ...... ............................... ... . . .. ..._..... ... ............ Address �E Address .......x"72-0.......... ---. .._ - ......... City Contractor's Name .__.. - ..Licernse ..et,,f�fl..7.3. Phone .....{f,C..&.. 3Y Installation will serve: Residence[Apartment Houseo Commercial❑Troller Court Motel 0 Other ...---•................... ' _Garbo a Grinder Lot Size �•••••�••••••' Number of bedrooms 9 ••••--- Number a# living units -."f -�- •--"- C_ _...... .............................................Private ❑ I Water Supply: Public System and name .......................... Sand Loam C1 Clay Loam ❑ i Character of soil to a depth of 3 feet: Sand❑ Silt C] Clay ❑ Peat❑ Y Hardpan E] Adobe Fill Material ----........ if yes,type ............... ............ I a i )Plot pian, showing size of int, location of system in relation,to webs, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet.) I PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size._.................:... Liquid Depth ....... ..................w I Material No. Compartments ..................... Capacity.- -••-----•----- Type -------•-•-------- Distance to nearest: Well ............ ........................Foundation ...................... Prop. Line ...................... -- Length of each line.. fo._r�.l_........_ LEACHING LINE � No. of Lines --------.�.....--"-- 9 _...... Total Length ....••... •........ Q 'D' Box .../_. . - Type filter Material �>,,/Z:,.�s•._Depth Filter Material .."•-.--•.••- ••� . /U.� ..... Property Line ... .,iir�..,....... � Distance to nearest: Well _../.1PP..��... Foundation ..__.... p tY ... SEEPAGE PIT Depth ._. �"-!-•--• Diameter _... .'�. Number .---•...../---------------- Rack Filled Yes ' No � .......................Rock -------•�--`�.y_......._ .� Water Table Depth ••------1v-----a-•---••-------- k SiI ----- �` ...............Foundation -------� ..:.._ Prop. tine ....4........_...... Distance to nearest: Well ./!�-- s ) ro REPAIR/ADDITION(Prev. Sanitation Permit# ---•----•-----------------------------••---- Date ------------------ •----- ----- '1 ................ Septic Tank [Specify Requirements .............----•-••----•--•.......................... N ----•-•-------••-------------------••------............... Disposal Field (Specify Requirements) __________________.................................. .. ..--••-• •............... ... ----------------------------- -••---•--•••--------- l - i (Draw existing and required addition on reverse side) ! hereby certify that I have prepared this application,and that the work will be done in accordance with Son 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: arson in such n►anner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subject to Workman's Compensation laws of California" Signed _.... • -•------------------------ Owner I __ -------------------• Title - --- - ...- .._.... .................. ....... If other than owner) BY -... �-----\�''#' Wert ---..__...........--- .....__. FOR DEPARTMENT SE ONLY APPLICATION ACCEPTED BY _. . ---.-- -- -•- ---- -...DAT!<- .._.:. --- DATE BUILDING PERMIT ISSUED -------------- - ---• -- •- ---------------•----- -. ...---• -----• ._.... .. ADDITIONAL COMMENTS -----------------------................ ...................... - ---------- • ..._. ---------------------------------------- •------------------------- -------- --•--- ------•---------------•----- D------------ - ------.............................. , __ ...---•- ate . . _... final Inspection 6 Eli 13 24 1-613 &V. 5H JOAQUI LOCAL HEAL DISTRICT 8/74 3M