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FOR OFFICE USE: pppLICATION FOR SANITATION PERMIT _ f� Permit No- -------------- -------------- (Complete in Triplicate) Date Issued .---•- - -~ -------------------- This Permit Expires 1 Year From Date issued l the work herein Application is hereby made to the San Joaquin Local Coy District for permit and existing Rules tand Regulations. PP application is made in compliance described. This app � � �.. 1 CENSUS TRACT ---- ------ f� ---- C �-1p---- ------ -- - -- - -� � JOB ADDRESS/LOCATION 3 _ -------- k (_ _ - ., - I ne Owner's Name --lC�4_ �' { Addressf �' Phone t - ----------- /2 `' ----- .License # � _��`_ - Contractor's Name Installation will serve: Residence partment House❑ Commercial ❑Trailer Court Motel ❑Other --------f---------------------------------- '� Number of living units:________ Number of bedrooms �-- ----Garbage Grinder __ _--___-- Lot Size __ -R-E —----------- Number --------•-- -----Private '' Peat❑ Sandy Loam .❑ 1 Water Supply: Public System and�name --------------- ------- - Clay Loam;❑ F . Character of soil to a depth of 3 feet. Sand'p5 Silt❑ Clay ❑ �,:• .�.. .w .�.. -- � _ _� .r . ' 'M' yes,type -------------------------- Hardpan ❑ ' Adobe ❑ Fill ateridl _. (Plot plan, showing size of lot, location of system in relation�o wells„build'ings, ,etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or see it permitted if public sewer is available within 200 feet' I �� Y_-. Liquid Depth -- Size----�-_-�-- - � - -�--- PACKAGE TREATMENT [ 7 SEPTIC TANK )M-0 �- { i t ---...PC'f��-!Material_ax�----- -�lo. Compartments ”--��--•--...-- E Capacity -f -- Type - '' r 1, Foundation Prop. Line V F istance to nearest: Well - ----___ r� • Total Length __� -•---•--•--• k LEACHING LINE [�No. of .Lines --__-_�--------- Length of each line_.____ _!-J� g D' BoxI - Type Filter Material 1�G-C -----Depth Filter Material _-___-1�-------------i- r �� '�`- --- Property Line, -��------�..:---- Distance to nearest: Well ___ - -�-- -_-fi- Foundation ----.-- ----- . 1 ; Number - Rock Filled Yes ❑ No .� SEEPAGE PIT [ l P Diameter ,• Depth'' ------- ---------- Water Table Depth --------------------------------- ---------------Rock Size -------------------------------- _-__Foundation - ___ Prop. Line --- ------------------ Distance to nearest: Well ____________---------------- -------------- - IDate ----------------------------------I REPAIR/ADDITION(Prev. Sanitation Permit -------------------- 4 -------------------------------------------•------- Septic Tank (Specify Requirements _.--_-------------------------------- - -------------------------- Disposal Field (Specify Requirements) --------------------------------------- -------------------------- ------------------------------------------------ ------------- -------------------------------------- ------ ----------------------------------------------------------------------------- _ (Draw-existing-and required addition on reverse-side) lication and that the work will be done in accordance with San Joaquin I hereby certify that I have prepared this app 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: "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 = --- ---- r-- ---------------------------------- Owner Title -------------- � f .. - - ---------------------------- By - r i - (If other than owner) FOR DEPARTMENT USE ONLY 1 . DATE `! APPLICATION ACCEPTED BY t -- --------------------- ----------------------DATE _._: -------------------- BUILDING ------------------ ADDDI ONAL PERMIT ISSUED NTSD-------------- --------- --------------------------------------------------------- ------- --- - -- ----------- - --------------------------- -- ------- -------------------- --------- +•� a --- - -------- - --------- ------- �. �,, Date , --- ------ -- --- -Final Inspec SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9. 1-'68 Rev. 5M