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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT A 40 Permit Not ---___ (Complete in Triplicate} �. Date issued ________________ __________________ _5 This Permit Expires 1 Year From Date Issued ,q all the war Application is hereby mde,.to the San Joaquin cek herein c wial th County ealth tO d Ordinance rict for a permit and existing Rules tand Regulations: described. This applications madsse,, p Joc InS _ ►'L ---------------------------- -:--- CENSUS TRACT �'�--- --------- JOB ADDRESS/LOCATION eAOVone �a -- ----------- Owner's Name ---�� .�.-:.:" _�.�. ,v. -"�--------�-----�------�---_ - ----•y----.�� ---------�f,['/a_F� --�-------�--- - -----------•- it 1 -----------� / �O S p m.. City. -.`�.. Address _ F .* + 3Sb Phone3�•-- ------- ------- r� `� !�� - S rp� I C � f"?_t��4__.license #p�so2 - -� - Contractor's Name [ '4_( ----------- I - �'� __ Installation will serve: ResidenceApartment House❑ Cominerciaf❑Trailer Court^', "I I 'Motel ❑Other -------------------------------------------- f � s Garbe Grinder : - Lot Size 1------fir-- ----------------- Number of living units:__- ----- Number of bedrooms _--------�. a I g ----------------- ----------------PrivateX Water Supply: Public System and name ------------------------- ------------------------ Clay ❑ t / fl eater_ _Sand Loam'-El Clay Loam:❑ Character of soil to a depth of 3 feet: i Sand lESilt i Hardpan ❑ Adobe ❑ Fill M❑tenial ------------ if yes,type " ------P---------------- buildings, etc. must be placed on reverse side.} (Plot plan, showing size of lot, Location of s�stem\in relation t- to\ -Ills, \ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) R r---- I SEPTIC TANK,[ l Size-------=- -_. _ Liquid Depth = PACKAGE TREATMENT } 7 t - , 1 w 0� Material--� ----------- I = No. Compartments:,-----_•-- I Capacity ----- ------- - Type -------- \ . Distance to nearest. Well ------ ---------------------Foundation ------ 1_1--- Prop. Line--------------- ' ---��Total Length -------------•-------=-••---- LEACHING LINE [ ] No. of Lines __._------------------ Length of each line.----------=---- - .. g _____DepthFilter M-aterial 'D' Box'_.__-------- Type Filter Material ___----_"--- t fV Distance to nearest: Well, ------------------- --�Foundation� A;�-- -------- - Property Line -------------------=-.-- `��' 1 = -� -NUT 11, Rock Filled Yes ❑ No I❑ - ` -- SEEPAGE PIT [ ] Depth ��------ ------- --- Diaine#er "-------- ---- � / - r � + k '`'?`_- ----------------hock Size --- �---------------- - Water Table Depth _-------------- --- -------------------- Foundation -------------------- Prop. Line --- ---------------•- Distance to nearest: Well ------ ---------------------------------- �� • Date ----- --•--------•-------•--------} REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------- ---------� ------------------- ------------- -�[ -------------- ��` Septic Tank (Specify Requirements} ------------------ .------- J a Disposal Field {Specify Requirements} ___7 -_,-_---- --- --------- ----- ------------ -- -------- ------- --------- ---- ---------- r---------- - l i ------- --- --------- ---------- - i {Draw existing and requi"red addition on reverse side) I h eby 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 licen- sed agents signature certifies the following: fersan in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subl t to Wor man' Compensoti n la sof California." Owner ' Signed i -- ------- ---•--- --------- - Title ---------- -- ----------- k BY ----- {If other than owner) FOR .DEPARTMENT USE ONLY r a,.-_ ---- - --� _-- - �.�-__ �. .._... DATE _ �'� �� ------- APPLICATION ACCEPTED BY.-f-_ -- ---- - --------------- --,_ -- --- --DATE -- °" BUILDINGPERMIT ISSUED -- -------- --------------------P ------ --------------=------------------------------------------------- ---------------•------ ADDITIONAL COMMENTS ------- ---- ------- -- ------------- - ----------- ----- ---------- ----------- ------ ------ L-,-;"--,- �Z ---- ------- --•------ - Date --- ------- Final Inspection by- -------- &Pr SAN JOAQUIN LOCAL HEALTH DISTRICT E, H. 9 1-'68 Rev. 5M