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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT Permit No. .... ......•..... .. ..... (Complete In Triplicate) .......__...............•-.............................. Date Issued .��'-�•---�3 This Permit Expires 1 Year From bate Issued l the work herein Application is hereby made to the San Joaq Iia to wits Health District iCountt©rd nan a or a Nom549 and existing Rules it to construct and tand Regulations' f described. This application is madein comp JOB ADDRESS/LOCATION ..........-j 'S' c-f �'fw'r _ =............CENSUS TRACT ......................... ..Phone �... . S" Owner's Name g / `� ...•....... 1.'i f -- Address `� --------------------- Y ------ cs.r c� ................. Contractor's Name ...--_-.- -- ' } t�rt2R.« _... ! ,.- �._ License # .0 ?5!� ._. Phone .. .� ._.�?�_... Installation will serve: Residence Apartment House Commercial []Trailer Court ❑ Motel ❑Other Number of living units:.....I.... Number of bedrooms c;.�......Garbage Grinder .--......... Lot Size ----••-•-- ...Private [ IWater Supply: Public System and name ..---_---------- --------;�.......:... ._ . CIn Loam – Character of soil to a depth of 3,feet:,,,....Sand.10—Silt-ED�Clay-x�•– Peot ❑ �~Sandy,toam ❑ Y C�- [ Hardpan ❑ Adobe ❑ Fill Material -.-...�,..`-. I YeS,type — /. (Plot plan, showing size of lot, location of system in;.relatio.nto wells„buildings, etc. must be piked on reverse side.) ! NEW INSTALLATION: (No septic tank or seepage pit permitted if publii Jewer is available witl?in 200 feet;)- �- n- .r E;. 1 SEPTIC TANK Size._E�ra� - .._ ._- qDepth PACKAGE TREATMENT [ n f CTS �3- Material---- rNo: Compartments - --- �. Capacity (2 . z TY�e '� • --: �. ---------- @ r T Total Length _.�` ��--n Length of each line •---•--•-•---- LEACHING LINE j No. of tines v� g i 'D' Box -_-.f Type Filter Material i c4e--•---Depth Filter Material ... .......... •....--••- Foundation ... - Property Line .................... Distance to nearest: Well ` s-- No �� Diameter ---.---•---.---- Number ........ Rock Filled Yes ❑ SEEPAGE PIT [ ] Depth .: ' Water Table Depth ........ -------------------.---------Rock Size _... -------------- Distance to nearest: We ------------------------------------- .Foundation . Prop. Line ----------- --- I . Date --------------- -------- 1 r REPAIR/ADDITION(Prev. Sanitation Permit --- --------------- Septic Tank (Specify Requirements) -------------•------ ments) ---.. - •-- Disposal Field (Specify Require .. - ---- -- ------ -.-....._._ ........ ---- . .......... ........ � (praw existing and required addition on reverse side) - [ I hereby certify that I have prepared this application and that the work willbe 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: "I cortify'thot in the performance`of the work for which this permit is issued, 1 shall nos employ any person in such manner as to become subject to Workm Compensaflon laws of California.” Signed . -- --�� -- - --------- -............. -----••------------------- Owner 1�%r .•. ........... ... ......... } B r. --•- ..........•..............•-- Title j (If other than owner) ( FOR DEPARTMENT USE ONLY _ ��.._------ DATE ... .._. APPLICATION ACCEPTED BY .....!:.............. .. .. ..._---._.._. - ............... ..•---�---•---------•----.. BUILDING PERMIT ISSUED ... ADDITIONAL COMMENTS ..__--=------------- ------------------------------ ..,......._.....__,..._.._.-.... -------- ---.._..---•... ...... ......I--------- ----------- .............. .... . -.-: --_-. --- --------- --------- ---------------------- --•--- -••--- Date XV. 7.3---------------------- final Inspection b ------ ------------------ ......... ._.._._._.._.......... . SAN JOAQUIN LOCAL HEALTH I5TRICT 7/72 3 M _..