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FOR OFFICE USE: �� APPLICATION FOR SANITATION PER�MIT.� Permit No: "'' (Complete in Triplicate) -----. Date Issued -�6-�76 j ------------- This Permit Expires Y Year From Date Issue ,+ r Application is hereby made to the Son Joaqucompliancein Lo c wial Hh Counealth DtytOrd Hance permit a d existing Rulesand Regulations, described. This application is made J CENSUS TRACT -------------------------- < f JOB ADDRESS/LOCA? N Phone Owner's Name . - --- --- ----- --- Cit --------- --- Address ----- _ G.J'------------- P, - 4 dry " ,�y� _ --------License #�----��-��- �- Phone --- ------------- Contractor's Name --- ------ - --------.---- --- Installation will serve: Residence partment House❑ Commercial ❑Trailer Court i❑ Motel F1 Other - - --------------------------------------- Number ------- ------ ------ ------ ------Number of living units:-------- Number of bedrooms _-'_%------Garbage Grinder ---.--- Lot Size ---------""- Private ❑ - -------------- -- Water supply: Public System and name --------------------------------------------------- ------- - -- - Clay ❑ Peat ❑ Sandy Loam ❑ Y pP Y� I Clay-Loam ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Hardpan ❑ Adobe I Fill Mater!al _4/d-_ if yes,type --_-- -- - - (PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank;or, seepage pit,.permitted if public sewer is available within 200 feet,) l SEPTIC TANK ize--�-- - --------------- Liquid Depth _. - ---- p PACKAGE TREATMENT [ ] ! -- -•--------. yp l9ws No. Compartments } _ -- T e _ Materia _ _:n� �f �l Capacity'-!t. - - ------ ----- -- - -- - - ------------Foundation - -----�L2-�---- Prop. Line --.-------•--=--•----- Distance+to nearest: Well 17 ---- Length of each line----- -.QQ Tota ! Length o�.l No. of Lines __� -- � -- ---'- - -�-- � LEACHING UNE [S�° ---------•-- �! ! ` �� De th Filter Materia! __- 'D' Boxl4J/J- ' Type Filter Material �1�-__. _-_____ p / j i __ Property Line �- ---------_--- Distance to nearest: Well ----=- ...... ---� Foundation ---t ; P Y I �' '_ Number Rock Filled Yes No C3 Detht �� ` S' , f Diameter -- - SEEP� AGE PET [,� P ! p / _ -------- ----•-Rock Size ��-------------------------- Water ----- -- ------- - / Water Table Depth _F. 1 t -------------------- Foundation -- Prop. Line pistance.to nearest. Wel! -.__.__-" - - ' t ------------ ------ Date ---------------------------- -----} REPAIR/ADDITION(Prev. SanitatlI n Permit# -------- ----------- - j ------------------------------------------ --------------•.,----- --------------- Septic Tank (Specify Requirements) _____________________ Disposal Field {Specify Requirements) --------------------------------------------------------- - f -------------------------------------------- ----- I----------------------- --------------------- --------------- i ------- --- "-" - ------------- 1 (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws; and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen� f sed agents signature certifies the following: per is issued, I shall not employ any person in such manner "I certify that in the performance of the work for which this p 1 as to become subject to Workman's Compensation laws of California." -- - -- - � Signed ---- --- ---- ------- ---- -- ---- -- ------- ------- ----- --------- - --- ------------- Owner ----------- ------------------ Title ----- -------- Y - ------------------------------------ ------ ---- (1f other an r) FOR .DEPARTMENT USE ONLY DATE ----- `------------------------------- DATE ----��•- -- ------ ------ ------------------------------ ------------- ------- ------- DATE ------------------------------------------- BUILDING ._-- -- ------------------- APPLICATION ACCEPTED BY ___. _-- ----- "---- -----------"-- BUILDING PERMIT ISSUED ._._ --------------------------------------------------------------- ----------------------------------------------------- - ADDITIONAL COMMENTS -----;-------------------------------------------- - ----------------- ----------------- --------------- -- -- i�1=-7Q...- - - --- Date --------- -- ---------- Final Inspection by I -----------------'------------------------- ---- I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �.-