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FOR OFFICE se. APPLICATION FOR SANITATION PERMIT Permit •�- �. •7•• - ..----"."" (Complete in Triplicate) Date Issued This Permit Expires t Year From,Date Issued L,/ rein Application is hereby made to4e4§671 n Local Health District #or a permit to construct and instal! the work he-, p Or inance o. 549 an exi ting Rules and Regulations:. described. This application is a i o Ii ce. C y NSUS TRACT ..........-.............. JOB ADDRESS/LOCATI N .: ... .. .. -"� ............. Owner's Name • G.-,.- aa.p.................................. -- s i A ........._. Address .......p�.l. Q '(�. �Y City _.....��crL _ / ....... Phone �u..._�.�....---,License # ! •��-. ..._ Contractor's Name --.E ► Installation will serve: Residence Apartment House] Commercial QTraller Court ] Motel ❑Other --. ......................... 1 Lot Size �...._....... Number of livingunits:... Number of bedrooms .-_ Garbage Grinder ..... p --••-- Private ..---'Cls ...............❑................................................. is to Water Supply:. Public System and risme ...............••--------• Character of soil to a depth of 3 feet: Sand /Adobe ilt[] Y ❑ Peat Sandy Loam ❑ Clay Loam Fill Material Y ,typHardpan ❑ ............ if es a ............... .. r aced on reverse side.) (Plot p showing Ian howin size of lot, location of system -in relation to wells, buildings, etc. must be pl �t permitted if ublic sewer is available within 200 feet,) � NEW INSTALLATION (No septic tank or seep ge p' c l ``�� Liquid Depth ..... .................... ... SEPTIC TANK� Size._7� ..--�--•----• ............ . PACKAGE TREATMENT ( e , No. Compartments ... "" Capacity Material--_-• -- Distance to nearest: Well ----------�� •-- ........Foundation ----/?............ Prop. Line Total Length ...t f............. No. of Lines ..._.. ------------- Length of each line---•-- -- ` ,� `D' Box .�..._....... Type Filter Material ..-----$... ._.Depth filterr Material .__.�_��f._ Distance oto nearest: Well �•- .---• Foundation ---..�.�__.---..._.._. Property Line .... .� !' Rock Filled Yes No Depth .......... Number _.. _ . _.. ............. 2....1 Diameter -• SEEPAGE PIT [ � p .. .. _._ 0-� . ..Rack size ....�....el!.1 .............. Water Table Depth --•-.•-------•-- !- .......... stance to nearest: Well -------------- -��..... ...... ....Foundation ---- Q......... Prop. Line .......... 1. ...... Date ----------•....................... Z REPAIR/ADDITION(Prev. Sanitation Permit# -------- .............. --•---. Septic Tank (Specify Requirements --- .............................. Disposal Field (Specify Requirements) -.-------•---------•....................."_-.-----------------• ............................................... -----------------•------- •-------•--------• -- ----------------- -------------------------------•---- ...----•-•-•_..._. ---_.... t . I `r ----------------------------- I !Draw existing and required addition an reverse side) Ih hereby certify that 1 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 licett- sed agents signature certifies the following: person in such manner "I certify that in the performance of the work for which this permit 3s issued, I shall not employ any as to become subject to Workman's Compensation laws of California:" --- --------- -------------- Owner Signed -------------=----------� - ----------- - ._..._ . e --------------------------------- By ---- -- --- �d►`. ..__ fit! _.. - -•---• - •---- (if other than owner) FOR DEPARTMENT USE ONLY - DATE .. P APPLICATION ACCEPTED BY .:.... ... .. . .... ...•--------- _------- --------------- - -------- --------------DATE ....--- --••--•--•--..._..._._....._..--- BUILDING PERMIT ISSUED _.._._... ---- --•-•-------------- ---------------------------------••------- ADDITIONAL COMMENTS ---_ !------------------------------------------- ...................... ___ _ ------11 --_.Date :- Final Inspection by- .............-..._.-- .._. -.- - - EH 13 2!i 1-68 Rev. � SAN JOAQUIN LOCAL HEALTH DISTRICT �� Ik - -