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APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: �/ Permit No. ...�7.�--�•�•• (Complete in Triplicate) ................... ... ....... ......... .... .. Date Issued ........... ... . .................................. ..............I... This Permit Expires 1 Year fromate :sue ade to the San Joaquin Local Health District for a permit to construct and install the work- herein pp liis hereby mapplication is made in compliance with C unty Ordinance Noand Regulations- Application 549 and existing Rules qlication described. This app ' - CENSUS TRACT JOB ADDRESS/LOCAT•iON .........Phone .......:... ........................ ....... ..- . Cit Owner's Name -........ .... Address _-. v one ......................••...... rise one�� YPh Contractors Nome ...------ Residence Apartment House❑ Commercial :❑Trailer Court 0 installation will serve: - Motel ❑Other ----...-----•------------------•----------- --•-••-..: Number of living units:-------�- Number. of.bedrooms _.. ------------ Grinder .-__.....-__ Lot Size ,R.._.._private Water Supply: Public System and name ----------------------- - r- - Clc loam Silt Clay ❑ Peat❑ .'Sandy Loam Y Character of soil to a depth of 3 feet: Sand❑ ❑ Hardpan ❑ Adobe-0 Fill Material ............ y_._ if es,type f lot location of. system in relation to,wells,.,build'+ngs, etc: must.he rlaced, on reverse side:} (plot plan, showing size o , NEW.INSTALLATION: (No septic tank or seepage pit�Permitted.if p�sblic sewer is available within feet,)' t�} SEPTIC TANK t ] Size_:..-- ....... _:__.. -- PACKAGE TREATMENT [ ) f -1 Na. Compartments .....--•- ......- Material------------------•- k Capacity _. __. ......_. Type Prop. Line ...................... i .---- . . Distance to nearest: Well ----.............'--Foundation . -. - ... length of each I;ne.__---••.................... Total Length ..........:...............`. i LEACHING LINE [ } Na. of lines . .._..--•-_.._ D' Box Typa Filter Material ...' .._. Depth Filter Material -----------••....- ...._... 4 Property Line --•. ::........... Distance to nearest: Well .... ............ fn ... . : .... Foundation ...._...---.:..:-•-----.- -No Number ............................ Rock Filled -.Yes ❑ ---•-._--:• Diameter .------•--•. SEEPAGE [ j Depth __..-i... . I --,--•--•-..._.._Rock Size ...... ` C Water Table Depth ........•.................. [ Distance to nearest; Well ••...... ............• ' Foundation -- ------ --------- Prop. .Line --.... - Q° Sanitation Permit# . Date -•----•--•--• ...............:....} REPAIR/ADDITION(Prev. Septic Tank (Specify Requirements) .........................-...... ........................ .................................ements) •••• .................. -- •--•---- ................ Disposal Fief ecify Reqv' -- -.._.�� •---••--••-----•- ... - _. � �'""'�- .A,;41_ delw. I � •-------' - � Draw existing and required addition on reverse si 1 hereby certify that { have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, ootid Rules and Regulations of the San Jaaquin Local Health District.:Home owner or Iicen- sed agents signature certifies the following: . °'I certify that in the performance of the work for which this permit is issued, 1 :half not employ any person insuchmanner as to become subject to Workman' ampensation laws of California." Signed --Z...---•-•. .--.... . Owner itle .. . (if other than owner) l/f FOR DEPARTMENT u5E ONLY iDATE ..... _l . _.7.. ............. APPLICATION ACCEPTED BY } --------•-----•-----•--•................... ....•---- ---..._... DATE BUILDING PERMIT ISSUED --.7 l.6�. ? A./.C"................__I................. .............I..._... : -- ..............__.... _........' ... ADDITIONAL COMMENTS ... ,!� f y _ } _:... ----- ......... ..................... ..----..........._. -- --••------ Date ............. _r.. ....... , !1 - F;nal.lnspection by: ..... .............. . . . SAN JOAQUIN LOCAL HEALTH DISTRICT. _ 7/72 3 M