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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: - '---- -------- -------------------- --- {Complete in Trip icate Dote issued - _______________________________________________ m -v This Permit Expires I Year From Date Issued P! I hthe District tlhRegulations rein Applicatio reb �esde in coSan pliace with CounttyOrdinana No. 549 and existing Rules and described. Thisapplication f JOB ADDRESS/LOCATION ._ -� _ L O-------•----- CENSUS TRACT - t TM _ R 1 - - Phone --------- mr---------- Owner's Name .--- ' Address --------------�_0- —BOK -X2. 53------- LIF1 }41Z` -------- CitY lli ---------------------- `� License•# ------.- --------- .-.-'Phone ----------------------•------ - Contractor's Name ------C�t�a1�--=----- ----------------------------------------;--- -- installation will serve: Residence ❑ Apartment Hou- ❑ Cornmercial❑Trailer C-arm . Motel ❑Other ------------- -- ------------------------- �. Number of living units:.__._�___._fNumber of bedrooms -----Garbage Grinder _-�_,i- Lot Size _.7--Z Private Ir Water Supply: Public System and name ------------------------------------ � �� Y u -- Character of soil to a depth=of 3 feet: U Sand❑ Silt❑ Clay ❑ Peat 1 Sand Loam Clay Loam Hardpan F1 Adobe ❑ Fill Material ----- If yes,type ------ --------------------- 4 (Plot plan, showing size of lot, location of system in relation to wells, buildings ; etc. must be placed on reverse side.} i i NEW INSTALLATION: (No septic tank or seepagege pit permitted hed iubsewer ��s��available within 200 feat,) PACKAGE TREATMENT SEPTIC TANK'_d / Liquid Depth _--- -------------- ---- Material -------- ---- Matera � Capacity -J---------------> TYpeR- ------.-=------- - t JO------ Prop. Line =� � Distance to nearest: Well __ �undation �------------ Total LINE No. of Lines 1---.r.� � Length of each [line .------- Tota! Length f,__-- ------------ � ' r `D' Box/yJr�-__ Type Filter Materia -fleptii Filt'eryMatenal ----- --- ---------------- j--`- . ' ice,--- -fCJ Distance to nearest: Well -----------3_0 Foundation ------------------------ Property Line. _____:___--- I Rock Filled Yes ❑ No 'C] SEEPAGE PIT [ } Depth ____________________ Diameter ____-__________ Number _____ ___._ i Water Table Depth ---------------- 4 __RockRSize. �k --------------------- .,r Distance to nearest: Well ------------------------------------ Foundationt`' Prop. Line -----------------_-- j ----- ---- ' Date ---------------------------------- REPAIR/ADDITION 1 (Prev. Sanitation Permit r# -------------------- „ Septic Tank (Specify Requirements) --------------------=------------------------ I " ( --------------------------------------------- -- -------------------------------------------------------- Disposal Field (Specify Requirements) --------------------------- tr� a -------- ------------------- - {` �� , ---- --- #, -------------- 1 ---------------------- ------ ------------------- I------------ ---- red -- --------------------: -- -- --- ---- - (Draw existing and required addition;obi reverse side} I 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. SonfJooquin LoccillHealth District. Home owner or licen- sed agents signature certifies the following- ' ollowing: "I certify that in the performance of the work for which this permit is issued, I shall ¢t employ any person in such manner i as to beta a subject to orkmanlCompensation laws of California.' ty -------------------------------------------- Owner Signed ..-�1JC�1-'`-�:�--- - - - � Title(• -------------------- - --- ------------------------ By --- -------------------------------------------- �. (If other than owner) jJ FOR DEPARTMENT USE ONLY i -•� - ��_t------- -------------- DATE __. -------------------- APP t BUILDING LiOPERM TC ISSUDED ----=?------------ ---=-- DATE ----------------- ADDITIONAL COMMENTS ----- -- - ------------- --------------- -------------------------- --------------- --------------------------- --------- ------- ------- ------------------- __--- ----------------------- -_- - -- --_- ___----_-__ _ _ ____ _ _ __ y- - -------- ----------------- -- - - --- --- _. Dare ------------- - inspe ------------- ction x _ i --- --- - - - --- - . - SAN. ._HEALTH-_151STRIC.T_,. _ _ - - _ - _•. i'. E. H. 9 1-'68 Rev. 5M