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FOR OFFIC, USE;' APPLICATION FOR SANiTAT10N .PERMIT Permit No'. -` w.. r -.---- {Complete in Triplicate) .^ _ - Date Issue --------------------------------- - This Perrnit Expires 1 Year From Date issued . -- -------------------- -- inar.a permit it and existing Rules and Regulations: - - -- --- - o the San Joaquin Local Health District d far a permit to construct and 'install the work herein application is hereby made t application is made in compliance with County described. This app ► TCr� ._CENSUS TRACT --- B ADDRESS/LOCATION ._�7C--�- ------------= J _:= = -------------------------Phone :------------------- JO - - — �r [�1-11-1z 1 1 Owner's Name rno -------- City T , o R -------- -----' _ 7.0_� - Tt1 --. Phone ------------------ Address -------- - ._ - --L-icense # ------------------ --- ; i Contractor's Name _-� � - Trailer Court --------- -- i.- - esidence Apartment House'[] commercial. installation will serve:,, -------------- � Motel E] other ---------------- - - -- - 21 1�C-[�.�� --------- I Garbage Grinder ` Lot Size --------- 1 Number of bedrooms 3----- Private [� Number of living units:------- - # - ------------------------'-- Water Supply: ` Sand u - Clay Loam:0 1 s Public System and, name ---------------, y Peat Sandy Loam LJ ., y .n 1}Silt❑ Clay - _. s- ----- Character of soil to a depth of 3 feet: ��ildings, -_-----=If yes,type .Hardpaetc. must be placed on reverse side.) plan, showing size of lot,i location of system in relation to wells, sewer is available within 200 feet,) f (plot p it ermined if public No se tic tank or seepage P PDepth ------------- NEW INSTALLATION: ( P{� } Liquid �eP SEPTIC TANK.1 ] j Size----------------------------------- PACKAGE TREATMENT { ] �{ Type a _-_-_- No. Compartments ---- s capacit -- p Material ; Distance to nearest: W "r ---Foundation - Prop. Line Y etl� - c i - ; Length of each line-----------.----------- - th ------------------•- l _ Tota Length No. of L'ines -------- LEACHING LINE [ ] Depth Filte Material _--------{- - `D' Box -..------- - Type Filter Material ---- ---------------------- Property. Line. ------------•-------••-- - ' Distance to nearest: Well;"-_--_-._.--'-.-- Foundation � Rock Filled Yes 0 No 0 � ! Number -..-- I SEEPAGE PIT [ ] Depth - ------------------ Rock ---------------- Diameter ,✓ '�--,, " Water Table Depth ` fRncR0Size ------------------------------- ---------------- --Water -..------ \ ------y------------- ----- ` /i. -'-----Foundation -. Prop. Line Distance to-nearest: Wel1; .---.--�'_�------ - -- I I �� ' --- ---- --�----- Date - -------------•---- -•-----•----- REPAIRfADDITION(Prev. Sanitation Permit# ------- 7 F -t- � Nu Septic Tank {Specify Requirements) ---- - - --- Disposal Field (specify Requirements) i �"f------ -------- - -- QD------------- - --------- --------- ----- r - Draw existing and required ---- -_ e - da., - • �ure�erse s-id�e) ' ------------------------------------------------------ ------ •------ .--- -,- •- -- -- -- � di ion on I ( t' t ' 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 San Joaquin Local Health District. Horne owner or licen- ` sed agents signature certifies the°following: 11 certify that in the performance of the work,for,which this ermit'is-issu ed, 1 shall not employ any person in such manner as to becom ject W km 's ompe ation-laws of--California., p _ . - i Signe ------- `- -"----------`�"- = `----' Owner ------ ------- - - / ` ---------------------- ------- - r 4-,.�: --- ----------- -- Title ._ ( (If other than-owner) ; ._ i F + `'FOR 6EPARTMENT USE ONLY ?- - DATE -- .. _-_. ------------ APPLICATION ACCEPTED 8Y .-_�--1---- �-- ; BUILDING PERMIT ISSUED --------- --------------------------------------------------------- ----------------------------------- f ADDITIONAL- COMMENTS--- _--- -- --------------�-' _-•__ _ __ _-------------------- _______ ____-._"_________________ _-- ---_-_-_-__.--_ _ _ "____ _ _____ ___ _ __ __ - _ ----- '-------- ----•---Date _ -'--- ---- - Fina! Iris _ ----'---- ---------- - _ - SAN JOAQUIN :LOCAL HEALTH DISTRICT 3 1 E. H. 9 1-'68 Rev. 5M