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Fi�R APPLICATION FOR SANITATION PERMIT Permit No. .7...•.:•• - •--......... �.............. !Complete In Tripticatel Date Issued ...... This Pormit Expires 1 Year From Date Issued .... ................ .................... and explication It—here sy. made San Joaquin l�wiHhACUt © O dlnarn a permit and existing nq Rulestand Regulations,ein described. This application is mode,in complion �''L•g ..._.............. ..........._ . ...............CENSUS TRACT .......................... JOB ADDRESS/LOC ...._ .. ..... ...j.......Phone ...... ............................ Owner's Name ' .. ........... � 7��:�........_.................................. Address ...� �._ � l ...._....Lloense,�#`{ �/ ..... Phone7. . ?+ 't .... -.. Contractor's Nome .._._ . .'` .._ ............... Installation will serves Residence❑Apartment House Commercial[]Trailer Court 0 Motel ❑Other _ }} ms .Garbage Grinder �Slzs Number of living unite:-----l----._ Number of bedrao .-�.�.�- M......................_.......�..................................Privets _.... Water Supply: Public System and name ................................. e Cla Peat❑ Sandy Loam ❑ day Loam Character of soil to a depth of 3 feet: Sand❑ Sl1t Q Y t Hardpan El Adobe Fill Material .�Q.if yes.type............... .......... . ocation of system In relation to wells, buildings. etc. must be placed an reverse side.) rpiot plan., showing size of tat, l �I it d if public NEW iNSTALLATIONt � (No septic tank or seepage p permitted sewer is available within 200 feet'Liquid Depth •/ �.•--• Size... .. �l SEPTIC TANK . ....�..�•--•-v�--•t•............... PACKAGE TREATMENT (-� -� ,,L ..- - -•_ Type -T Material =�-'�� No. Compartments ..._...---•--•--...... Capacity . .. . y ....... I ...i. .....---•-- _.... .Foundation . .... Prop. Line Distance to nearest: Well ..... 7d / ........ �. length of acs► line..._ •• Totalle �h •-- =_EACHING LINE, [� No. of Lines _.._ .1_l... ..... Type FiltertMater a! : ...Depth Filter Materia! ..... . ... .�.. 'D' Sox . .._ YP t.�..�.............. Property line. .............. . �_,Distance rests Well fl... Foundation x ° � � Rock Filled Yes �`i SEEPAGE PIT [�pth, ;.! ........... .Diametterr .. ...... ,Number 1/1—A-:1.1 ...�... .. 3 ij...._.. s w ble a tri ------ —d.f...... ..................Rork size ....l..l�t.1�. Water Ya F i � d .. . ......... Prop. Line -•-•-•--•- "" Distance to neatest: Well P•• •- •••--•-••--- .....Founation I REPAtR/ADDITION.IPrev. Sanitation Permit# •-••.... . ... ....................... Date ...............4....�........••... � F . . ........ ...` .................... .................. . Septic=Tank !Spcify Requirements! ......................................... ......... Disgasa! Field (Specify Requirements) ...-----•••--...._..--•- _ x-..................................................... ................................ ..................................•--........:......------•------- ..�__.----•......... ._... •-.....:...............................................I.....--••--•-•---. .....--. .._. . . ................••••. (Draw existing and required addition on reverse side) Ihereby certify that I have prepared this application and that the work will tae den* in accordance with San Joaquin ovnty Ordinances, State Lows, and Rules and Regulations of the San Joaquin Local Health District.Home owner or licen- sed agents signature certifies the following: ermit is Issued, I shall not employ any Person In such manner "I certify that in the performance of the work for which this p as to became subject.to Workman's Compensation taws of California:" Owner -- :,:fined . ......................................... Title ...... ........................ ................. (If other than owner! FOR DEPARTMENT USE ONLY ............. DATE . ....•" ........ ............. APPLICATION ACCEPTED BY -- -- """"" BUILDING PERMIT ISSUED ........ .... .........................._..._..._.................... ADDITIONAL COMMENTS .... ..... ............... ...................................................... ...................•-.---• .....................................I....... - .. ........ ....... ........ ................................ ................._................................. . . .... •�` .. �`1t'�? -+-. ....._... :.__. .._.`_...._..... _............................ ........ p-- .. ................. . i ...... Date ..'rl. .., r........ Fina{ Inspection by: _. ._ ^�•�"_.,,'� •.•.............. .. Eli 13 A 1.0 Rev. !M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M