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FOR OFFICE USE:. r- APPLICATION FOR SANITATION PERMIT .. Permit No. ........ ........ .... (Complete in Triplicate) --..... _.. _.. ........... . P Date Issued This Permit Expires 1 Year From Date issued ork il to construct and Application, is hereby made to the oin compliance Joaquin cwith Coual Health ntytordinance Norict fol a . 549 and existing Rules tand Regulations: described, This application �s Trade in - • s�+tr •...- CENSUS TRACT _.... JOB AgDRESS,!LOCATIQN �� -- � �--� - ---- Owner's Name e ti......... ----- City ,4�•__ ��.' ..---- • ...... .................................... Address _...._1�.._/.�_.�z�-... _�.-_�s•t..c... ... - -----� --- --- - - ............ --.-.License � ------ ......... --_. Phone ...........--................ Contractor's Name... _. ......... ........ Installation will serve: Residence f2 Apartment House [i Commercial Trailer Court ) Motel 7 Other - ----------------- -- --- 7 _ Garbo e Grinder .... Lot Size ti?. `'"+'... ._ ........... Number of living units:_.. Number of bedrooms .-...... 9 PrIvate Water Supply: Public System and name .--. .._._------ Character of soi' to o depth of 3 -eet; Sand ❑ Silt d Clay ❑ Peat Li Sandy loam ; ] Clay Loam r_'j Hardpan D Adobe f". FIII Material If yes, type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: jNo septic tank or seepage pit permitted if public sewer is ava�lable within 200 feet,l r _ Size _.. -. Liquid Depth ..... ................ . PACKAGE TREATMENT SEPTIC TANK f Capacity ... . -------- .Type -------- ------- Material ......... . No. Compartments _..-----........•.... Distance to nearest: 'Jell _.- ..• ----- - .__Foundation ........ __ ._. Prop. Line ...................... I Length of each line-._..ti.!�........ . .... Total Length . �........._».......- LEACHING LINE jp] No. of Lines-. , 'D' Box _. Type Fi1•er Material Depth Filter Material _.�.Q .._.. _._.•..•.._ Proper ro er Line .b....- Distance to nearest: Well _. � G---------------- Foundation -• P SEEPAGE PIT [ j Depth -- ..... Diameter ........------- Numbe- .-...-... -.. ---- --- Rock Filled Yes [] No Woter Table Depth ------- Rock Size .. •.... Distance to nearest: Well ._. ..._...... ........... ...----..Foundation __. Prop. Line --------• ..._..._.. REPAIR/ADDITION 1prev.'Sonitation Permit i# ...........---................ Date ...._.. .................... } Septic Tank !Specify Requirements] _- -----_....... .... Disposni Feld (Specify Requirements} -- - ------- -------- .....................•---.... ....... - - !Draw existirg and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance vAth 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: "I certify that in the performance of the work for which this perrrrit is issued, I steall not employ any person in such manner as to become subject to Work marf's�.,Campensation laws of California." SigredOwner /�, r..-, s.r Ow ------- --------- g_ ----- Title .................... ..._.... ._...... - y_.......-----•.............. .... If other than owner} ` FOR DE ARTMENT USE ONLY APPLICATION ACCEPTED BY OATE----•-- .... PERMIT............ ... •- -.. ---- ...DATE ........................................... BUILDING ISSUED - - - ADDITIONAL COMMENTS ._ ..... .. ........... ....... ..................-.._._. .., _.. .. ..-. .......................... _.. �... _ _ .. ...C.�f :-.:..:...:.:... :::. :::..... .-- L .................... Date .. .. Fina. Inspection by: -.- -- SAN JOAQUiN LOCAL HEALTH DISTRICT F u a 1 -'f,R Rev. SM