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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit "' (Complete in Triplicate) Date Issued . •f�1� This Permit Expires 1 Year From Date issued ...................................................... c.,r.. Application is hereby made to the San J'oaquian ecwith County dinars a permit and existing g Rulesct and tand Regulations:reirti described. This application is made iri'complianc CENSUS TRACT JOB ADDRESSAOCATION ......_.. ..Phone .................................... ......... Owner's Name . ................ k .... • - City � Address ..... .......... Phone ��_ 2'N..................... Li ense # Contractor's Name ..._ ..-� f ; ��.. .._... PO .. installation will serve: j.Residence `Apartment House 0 Commercial []Trailer Court ' Motel ❑other .............. •I--....••••...---••-••..... Number. - W�_ " v.F a•- r••-•:.........•....__� Number of living units.-._/.......Number.of bedrooms -`:� ---.Garbage Grinder I.V ---• Lot Size •` - ,® ---..... ..:..Private 1 Water Supply: Public System and'n ome `...........:!•...................... ClaY Loam Slit Clay ❑ t-❑ Sandy Loam ❑ Character of soil to a depth of 3 feet: Sa ❑nd [] ea e ....................... Hardpan , Adobe ❑ Fill Material _........... If yes,type (Plot plan, showing size of lot, iocafion of.system in relation to wells,'buildings, etc. must be placed on reverse side.) 9 '~ it permitted if public sewer is available within 2b0 feet,) NEW INSTALLATION: (No septic'�ank or seepage p p ••. •••---......... �SEPTIC TANK�� ] Size......••-----....---•........................... Liquid Dept ..._... PACKAGE TREATMENT [ ] •`;_� . - .y-- _. 4 . ..... .--•-•----••-•- No. Compartments .................... Material...................... Capacity ..... ......... Type .. x. a Distance to.,nearest.. Well ••---- •-f••-!r `-Foundation ...................... r f e ...................... LEACHING LINE [ I No. of Lines _-__......_ Length Doff each line-...-- Total Length ........... " x .Depth Filter Material •---------------------- a p' Bax Type Filter Materik ..._..... } „� Foundation Property Line .......•......--•- • 1 ................ Distance to neares#: Well ........'--.---•---•--• • • Rock Filled Yes [] No ❑ 4 . Number Diameter .........................• - De Depth ................ SEEPAGE PIT [ 7 p ^-_- ..,. - ..Rock Size Water Table Depth-.- . .....................:.......:.....:...... w t Foundation Prop. Line ...................... Distonce to nearest: Well -•••••-- s Date REPAIR/ADDITION(Prev. Sanitation Permit# .......................... ----•-...... !! .f Requirements) ............................................. ' Septic Tank (Specify q - � f Disposal Field (Specify Requirements) • •-”' � , ......................................_...---- ............. ...-----..._ : ............._.........-----....---....._...... ..._.. - ' •... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this app lication and that the work will be dans in accordance with San Joaquin County Ordinances, State Laws, Rules and Regulati�s�f the San Joaquin Local Henlih District. Horne owner e: ten' 4 sed agents signature certifies the Following: to arson in such manner "I certify that in the performance of the work for which this permit is is"W. I shall not employ any P as to become subject to Workman's Compensation laws of California•" tN iOwne -------••-•............. . r ; Signed .................. I By ................ ... . .an • Title _... (1f other than owner,) -- FOR DEPARTMENT USE ONLY DATE ...��: .i �-- ............ APPLICATION ACCEPTED BYE' DATE BUILDING PERMIT ISSUED --------------------------- -• ----.....-------•--................_...---....••-- - ADDITIONAL COMMENTS ........................ ... 1 : ................._...... ::....__.....---•--•••................. --....._ .._... .....••••. • . -— .. D f , ............................. .. --•---..... to _........�:. ....... ...... ........... Final Inspection byt ....... ....... t SAN JOAQUIN L LOCAL HEALTH DISTRICT i 7/72 3 M