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..:. .�� - FOR OFFICE USE: AppLICATION FOR SANITATION PERMIT fp Permit No- ------------------- >, , ---- ----- 1 (Complete in Triplicate) ;="",: ------------ ---------- Date Issued •---------- ;This.Permit Expires 1 Year From Date issued � ----------------------------'----: ; and e work rict for a rmit to cons Application is herebrein y made to the San Jo�c(uin�oewith Coualth DytOrdinance No. 549 and existing Rules tand hRegulations: described. This application is made in complio CENSUS TRACT --•----- _14"6F_A4_* JOB ADDRESS/LOCA? N .___""-- X_<S -_/41Phone .--- --!6� / �; 'T -- • Owner's Name i---co---�- --------; " city ". ------------------------------------------ Address -------------------- -- /� Phone - License #IDs ----- gr Contractor's Name --"------------ Residence A ❑ Commercial Trailer Court partment House '[] Installation will serve: _- ------ Motel�Other ------------ ---- -- ------ ------�"�-------�, ---------- r a�� ° �� "- Lot Size --- - -- -------------------- r� Number of bedrooms _,3`---Garbage Grirer -" . __" - Number of living u -- Private ❑ Wafer Supply: Public System and—name ----------------------------- , C!a Loam 0 I Silt❑ Clay ❑ Peat ❑ Sandy Loam ,❑ Y� Character of soil to a depth of 3 feet: Sand'❑ Hardpan E] Adobe Fill Material _�l_:_ -_ If yes,type ---_------ laced on reverse side. (Plot plan, showing size of lot,`locdfion of systems-in. relation to wells, build'+ngs, etc. must be p I it permitted if public sewer is available within 200 feet,) ,r NEW INSTALLATION: (No septic tank or seepa e p p i -- 9 ---- - Liquid Depth - SEPTIC TANK �ze----------- - ' i PACKAGE TREATMENT ( 7 , /,- _^........ Capacity / tY ,%(Ype -------- Material_ e" � No. Compartments Pro Line "'----•- 4��w ( t n!".- F ------------------------------------ ------ -- ------ --=---------Foundation ----�------- p• Distance-to �tearest: Well - "_-_--"_ LEACHING LINE ( a No.of� ine - =iT' a` Length of each line----------------- - E ------------- 1 Total Length t -------_-- -.f_--_Depth Filter Material ----------- `p' Box __.__ -_ Type Filter Material r- _' _1 �, -" Property Line D�stonce}to nearest: Well ---- ---- -_""--- Foundation ------------ - --------- Di ---- - ' Number -------------------- SEEPAGE ---- - ----------- ' Rock Filled Yes ❑ No �❑ SEEPAGE PIT L 1 Depth aF i_=-----=- --- Diameter ------------ 2 Water Table..depth -Rock Size -------------- WaterTa ---------------------------------------------- """ Foundation Prop. Line ------------- ------- Distance V-61 1-------.---------------------•--- 4 REPAIR/ADDITION(Prlev:�Sanitotibn--Permit.# ----•---------------------- ---'--- c ----- - Septic Tank (Specify Requirements) --------'--- j ------------- Disposal Field (Specify Requirements) -__- ------------ - 2 i -�- 3." ---- ` I --------- - ------ (D'raw existing-an, required addition oa�reverse ;e -ti4 hereby certify that I have prepared this application and that the work will be done in accordance with San 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: a. 1erson in such manner "I certify that in the performance of the work for which this permit is issued, ! shall not employ any p 4 as to become subject to W0 km_an� Com ensfit�on laws of•California." > r 4 Owner Signed ------ -------------------------------- - ---�''�---- - ---- -- -------------- ------------------- ---------- Title --- -------- --- (I other t an o r) _. FOR DEPARTMENT US ONLY ------------------- --� DATE -.� ------- APPLICATION ACCEPTED BY .___-�-- - - DATE ---------------------------------------- BUILDING PERMIT ISSUED ----- ------ ------ ------- ----- ----- --- --- -- -- -------- - --�--- --- ADDITIONAL COMMENTS ------------- ------- y -- ----------------------------------------------------------------- ( --- ------------------ -- r— - ------ ----- - Date Final Inspection by: .-_ -- -- ----- .--___ -- -- -------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 7 , E. H. 9 1-'68 Rev. 5M