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FOR OFFICE USE: ^�� - `�"" { - - ......... APPLICATION FOR SANITATION PERMIT "-..------ (Complete in Triplicate} --•----•�--- --- -------- ---- Permit No: ."� ----------------- it I -------------- -- This Permit-Expires ] Year From Date Issued __ - Date Issued _--�-'�� 7 7/ Application is hereby made to the San Joaquin LocalHealth District for a described. This application is made in compliance .with County. ice for Ordinance:N r t t and existing Rules permit to construct and install the work her v` and Regulations: JOB ADDRESS/LQCATION JOVi FF i -D- ---- -_ CENSUS TRACT _5.`0 ; Owner's Name -_;�_--`- " ' -----------.------- ---------�>-------------------Ph Address .- __�J Z.------- S one ----------------H�--. I Contractor's Name_- ."- - - CityF______.- [/ LQ/v' ----•----- Installation will serve.. ----------.License #•_----.----------------- Phone ----------- - --- - -- -- - - -- Residence Apartment House❑ Commercial []Trailer Court ;❑ Motel ❑ Other ----- -- ------------ Number of living units:_.__1_--- Number of bedrooms _ Water Supply. --•-----Garbage Grinder ----- Lot Size pp y: Public System and nameM -_ w �� _ _--___-- Character of soil to ❑'depth of 3 feet: Sand ---'""'"" ------------ -- - --- ----Private = ❑ 1 Silt❑ Cla Y ❑ Peat. f �� .❑ ❑ndy Loam � CIa Hard an _, y rt,,,::_._ _ - Y'Loam.❑ p ❑ ( Adobe ❑ Fill Material a -- -- If yes,type (Plot plan, showing size of lot, location of,sys m in relatloh to wells, buildings, etc must be placed on reverse NEW INSTALLATION: (No septic tank or ee e J x � _ side.) �. P g pit permitted if public sewer is avai able within 200 feet ' `f PACKAGE TREATMENT ,) ` p Y TANK[l Size r ( 1 SEP71C -- ---- Liquid Depth Ca acit ,. -_----- - - ---- T Pe -------------------- Material-------------------- No. Compartments ----- � -vDistance to nearest 11 ------------------------------------ LEACHING LINE- VN Foundation -- ------------------- Prop. Line ----- ------ �'' [ 1 No. of Lines Length of each linez --- ------ Total Length ------------ V Box -"-__.- -_ Type F Iter Material ---------------- "Depth Filter aterial -----------=-•----- . Distance to nea.'rest'-W l _ _ " , --__-- Foundation,.______________ Property Line SEEPAGE PIT �'f v � ] Depth --- - - -� s- --�}Di meters �' � --- ------------------•----- i ,.._ Number - -_ __ "- _"_ " Rock Filled Yes ❑ No x : Water ;Table Depth _ _ - .:; Roek Size;'---- -- ---- Distance to nearest:' Foundation : - Prop. Line ---------------- -- f REPAIR/ADDITION(Prev. Sanitation Permit# --- -_------------------------- ---------- Date 1 Septic Tank (Specify Requirements) --- ( A ----:--- - Disposal Field (Specify Requirements) __ - _ '�y ' e � - ,t 4r - =�ti. - --- -------- -------- y ----- --- -" ------ ----------------------------------------------------- -`- ----- -- (Draw existing and required addition on reverse side) 1 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 Rocal Health District. Home owner or licen. t sed agent#sina ure certifies t e following: "I certify he perfor ce of the work_for which this permit is issued, shall not employ any person in such manneras to becoject to W man's Compensation laws of California." Signed - ' Owner BY ---- ------ ------------------------------- -----------t ----- -----(If other than owner) Title ---------------------- # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By ."7 _ i " ---------------------------------- ------------------- ------ DATE BUILDING-_P_.ERMI.T._.ISSUED..-_-___ _____ __ ADDITIONAL --------•--------- COMMENTS ----- ------------------------------------------ -------------•-- ------ ""DATE _ - . s -. _:; Final Inspe41 --._..._..___ . _ _... ------------- -- -----Date ..... t SAN JOAQUIN LOCAL HEALTH DISTRICT } E. H. 9 1-'68 Rev. 5M 7-3