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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /-� Permit No. - ._ .............. ........................................ -- - (Complete in Triplicate • - --- --- -- - p Date Issued . ..._.....- .. ..........I...................... . � .-- This Permit Ex (res 1 Year From Date Issued ........ ......... and he work herein deoSon Joaquin Health District mti tlt descApplicationibed. This applc o ismaden co liane wihCounttyOdinana permit and existing Rules and Regulations: [ _. CENSUS TRACT .... ........ ........... JOB ADDRESSAOCATION . ...1P2-•-. 1 one ........ - Owner's Name ............... •-•------- ._.----...- --.......... -y✓ _... . . _ .------•--••-•--........ Address _ _ .license # --��83X-7�Phone .............................. Contractor's Name.- _ Installation will serve: Residence Apartment House❑ Commerci I ❑Trailer Court Motel ❑ Other .. - �- I rr Garbo a Grinder Lot Size .... ._ -� I Number of living units:.....' .._. Number of bedrooms 9 .- -- ---- ---.Private r Water Supply: Public System and name ...... ..................................... Character of soil to a depth of 3 feet: Sand.❑ Silt C3 Clay 71 Peat�� Sandy Loam El Clay Loam F_ Hardpan r;• Adobe iJ Fill Material .... ..... if yes,type ------ .... - --- -- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) lNEW INSTALLA71ON: (No septic tank or seeps a pit permitted if public ewer is available within 200 feet,} f /—� Liquid Depth 14-------------------- 6\ PACKAGE TREATMENT [ ] SEPTIC TANK(!j Size ...9 ----- q p `' ' No. Compartments - Material._- p -�'''._.._..... l � Capacity ��Q . Type . r \ ,,,,,,Distance to ne est: Weli - °..... . ... ......Foundation �.n-.----•••- Prop. Line ...5--.----•-•.... ` 1 ... Length of each line... ------------- - Total Length .... _�--- k LEACHING LINE [ No. of Lines .... ........ . 9 'D' Box:"�.---. Type Filter Material , ..-Depth Filter Material 1 -- i- t L �S'O�- ----- Foundation .... ..J.o . .. .... Property Line ....S. .--.-- - Distance to nearest: Well 1Rock Filled Yes E] No (3SEEPAGE PIT 11 ( Depth . ----- Diameter Numbe• -_ -- - - Water Table Depth --- Rock Size _. --- -- ---------- . t l ._. Pro Line _...._..... -------- Distance .......... _-. REPAIR/ADDITION(Prev. Sanitation Permit# •._----------------------- .._. Date -----------------2=1------------- I Septic Tank (Specify Requirements) -.------ -••••••-.....................-.................. Disposal Field (Specify Requirements) _.. -_...-__•--•---_-••----------------------------------------------------------- ..................... `--. .... ..- I .... ...................... . -----------•--------•-------- ---- 1 ... ........ y ._.. ..-...-. ........ ...... ........... _. ! _(Draw existing and required addition on reverse side) I�hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin s of the San Joaquin Local Health District. Homs owner or lict:n- County Ordinances, State Laws, and Rules and Regulation sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ...--.._ ----- Owner g (If other than owner) ' FOR DEPARTMENT USE ONLY—�—_ - - •-•---•- DATE �.Jl�'.7L..----• ..- APPLICATION ACCEPTED -BY ---'--•._"• ..........t�Y► f'�'u.... .........•_:...............-- DATE .-----. ...................... .... BUILDINGPERMIT ISSUED .......................................................... ._..__.. ADDITIONAL COMMENTS .. ' ....--------• ..•...............................•-----.----- -- i s _... __. Date �l l . - - Final Inspection by: r _ .._...... .......... SAN JOAQUIN LOCAL HEALTH DISTRICT ` E. H. 9 1-'68 Rev. 5M,___