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FOR OFFICE USE: FOR OFFICE USE: APPLfCATION FOR SANITATION PERMIT permit No. 45 n 11 ------------- ----- --- (Complete in Triplicate) ''� Date Issued._ -/l` - --------------------- --- ------------------ ----- --- This Permit Expires 1 Year From Date ••--•----------------------- --- issued I permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health District for a p n G This application is made in compliance with County Ordinance No. S 49 and existing Rules and Regulations: e ) � .CENSUS TRACT..- -,- ------ ------------- . 1 - sT JOB ADDRESS/LOCATION --- --- -- one---------------- -- - ----- -- - # _ � F.�r . Zip -:-- Owner sName.,----- - _. ._... _ - _� City �.p k �� -_ ._ - --.__-._' _-__.__-__ - 4 -.----- f----_c_ !J ___-___ Address- ---- - i..... .. ...:� /� .' tens ----- --- one_ a ._ Ph Contractor's Name_-_-_--- -- ; . - artment House.❑ Commercial ❑ Trailers Court ❑ installation will serve: Residence AP -- �, r Motel ❑ Other ._ = i i ,.r -r.-- r � Garba a ----------------------- -------------- Grinder. - '_Lot,Size - . I Number of living units:_ - -- --1____Number of bedrooms ; - -- - g Private ' ..r 1 Public System and name------------ - ' �Cla Loam ❑ Water Supply. y —•.•-- Peat ❑ �_;�Sandry�Loam ..�� yam_ --- -�. Character of soil to a depth of 3 feet: r Sand ❑�Silt❑—Clay-�1 _ Hardpan [I .'-Adobe[I_ Fill•Material-_ 4: -_-If Yes, -- must e �f showing size of lot, location of system in relation"to wells, buildi#gs,tetc is a�abableawithon 240 feet ln reverse de 1 00 (Plot plan, s g „ .. it permitted if public sewer a NEW INSTALLATION.- {No septic tank or seepage p' P - < z _ ..---------Liquid Depth.Y------------------- --$ize----------- PACKAGE TREATMENT [ ] SEPTIC TANK [ - P- f Prop. Fi.--.� Ca acit ------------------Type.-:: Line Material_.__- _- --- '-No. Com artments____------ ------------------- I PY -------- Distance'.to nearest: Well----------=---------- Foundation P •p ----------- No.'of Lines --.-:Length of each line------------------ No. ----_-_--_---- _ Total Length LEACHING_ LINE, [ 1 •-------------- _.!r D' Box--------- TYPe Filter Material s__-__. Depth Filter Mafieria!_-°------------ Foundation—-_ -- Property Lin Distance to riearest: Well__ __--- • - �4 R••-� ❑ i .. FII N fi Diameter-------------------- ------------------ SEEPAGE --------------- - s Number e !- ----- -----_Rock ed iYes❑ Depth 0 SEEPAGE PIT [ l P .. ._ Size, -----=---- :: Rock P L Water Table-Depth- Dis#ante to nearest:V+lell-T . Foundation------------------ ------- roP• Line_ E- r ---=--------------- REPAIR/ADDITION [Prev, Sanitation Permit#-- -=- _ � ---------------------------------- ----------- _ ,. a ------------------- --------------- Septic Tank (Specify Requirements)----- - u.c..�-- DisLposal Field [Specify equi ements): _ ----------- - ..� y.� . i ' ---------=-------•--'-----¢----- -------------=------=--------------.------------------ ------ . --- ----------------- ------- . � �• ~ ' (Draw existing and required addition on reverse side) I hereby certify that I have prepared ihis application and that-the work will be done in accordance with San Joaquin County lotions of the San Joaquin Local Health District. Home owner or license aged s Ordinances,' State Laws, and Rules and Regu signature certifies the following: person in such manner as I "l certify that in.ihe performdnce of tfse work for which this permit is issued, 1 shall not employ any .. . to become subject to Workman's Compensation laws of California.".' r - _. Owner , Signed_' - - -- _ - Title :- By-- ----------------- Y -------------------------- (if other than owner) - 1 FOR-DEPARTMENT USE ONLY t � _ DATE --- --- �`- ----- APPLICATION ACCEPTED,BY--Z - DATE_. ---- ----- ----- ----- ---:-- ---:- -�-- ------ --- --=-------- --- ------:-- -------------:-------- - DIVISION OF LAND NUMBER-..----- ---- - _ - _ _ ------------------ ----- - � ADDITIONAL COMMENTS----------- ------------------------------------------------ ----' ---- = -------------------=------- -------- ----------- -- -------------- ------ 1 ------- --- _ - - -- --------- a� e ----- Dat -- � � -- - --- - - 7 6 r Final'Inspection b '��---- 1---- '--� _" - F& 1677 REV. 7 Y� ------ EH 13 24 SAN JOAQUIN LOCAL HEAL. DISTRICT