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FOR OFFICE USE: € ..................................... ............. •-•• APPLICATION FOR SANITATION PERMR 1 ,.__ ...... e a p (Complete In Triplicate)w Permit No. . . s._...;3. ........................ .... . i Thls Permit Expires ? Year From Date Issued flats issued ........ ...... Application is hereby made to the San Joaquin Local Health District for a permit to canstr - described. this application is made in compliance with Coi unty Ordinance No. t t and uct and install the work herein 1 JOB ADDRESS/LOCATION ... Jf existing Rules and Regulations; ' Owner's Name .._,___.._. © T N ._- .�,? f Q.P....CENSUS T RACT ............... ....... - ...__...11 Address .... P hone.T---•-- Contractor's Name .....:......... . _---•--- City - Installation will serve: cense orfs . ..........: . ? Residence NA,partment House[] Commercial�,]Traiter Court 0 Motel p Other Number -•--....._•._._ - - g units:.._ . Number of bedroo ---- Garbage ge Grinder Water Su bedrooms -i Public System and name ize ,. ... .:l ......_... ••--...._..--- Char - - .._.. + atter of soil to a .__..... ....( - • .1�,�_ ......Private Q depth of 3 feet- Sand Q Silt❑ Clay L7 Peat Q Sandy Loam Clay Loam C) �. Hardpan[] Adobe 0 l=ilt Materia! ...:_....... if yes,type... (Plot plan, showing size of lot, location of system in relation #o'wells, buildings, etc. must be . . f NEW INSTALLATION: (No septic tank or seepage pit permitted If publlc sewer is avplaced on reverse side,) r PACKAGE TREATMENT [ SEPTIC TANK{ ] available within 200 feet,) f Size.---•............ ._.. Liquid Depth °p°GtY -----------•--•-•-- ........ Material.---- �. ••-------- rnpartments Distance to nearest: Well •---•................. LEACHING ..........----•-•--_--foundation Prop. Line._;_ J LINE d l No. of Lines ._ ;__.._..._... L' ----••---•----- Length of each line...... _ __._: Total Length ....._....; 'D' Bax ...f.--- � � ._..---••-....._.V� f -- Type Filter Material .................. .De Depth Filter Material Distance ton r pE --...._I............. earest: Well i Foundation i •--..... SEEPAGE y......_ r , - EPAGE IT ) 1 Depth 1 �................. ... Property Line I In ! - -----• Diameter � ....... ! •----••------- Number '---• Rock Filled Yes ❑ No C3 . ` Water Table Depth I ---_...----•----- ---------------------Rock Size Distance to nearest: Well _�............. Foundation REPAIR •-•-•--•--------...-•---...... ._. Prop Line/ADDITION Prev, -•••••....... l Sanitat,on Permit i _ -- ........... .. --•- Date ...__.._.. Septic Tank (Specify Requirements) I- -------------•--- .......... .,.__. Dis osal r _^.. .. p Field ( p Requirements) P le�-b� .._.. _ ..... ............... ..• r C/ --.-- - •---••_. •.--•--------•- - t......._.... (Draw existing and required addition ore re arse side)... _.. I hereby certify that t have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and this and Regulations of the San Joaquin Local Health:District. Home owner r sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shad) not en+ptay any, arson in A Ilcen-� as to o—me su let o orkman's Com s l ) I P n laws of Cal' rnia." .FP � such manner , Signet! _-`! - _ ^ - - _—Owner - �J . (lf other than owner) ! -,� �itie U ` _ . ._ .. •---••------ FO DEPARTMENT USE ONLY APPLICATION ACCEPTED By. -- --1� ---------------------------- _ BUILDING PERMIT ISSUED ---------------------- � - DATE ---...._..--•- • ............... ... ADDITIONAL COMMENTS ..__.._..-- -----.....................•----•-••---...._..._._......_.----- • - - ------------------- DATE _... ----•------- ---• --- . --- ..................... y. _.............................. Final inspection by: - --- - _... -.-••.-- EH 13 2 .�� 1-b8 Rev. M '-••---•..._.._Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT �