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FOR-OFFICE USE: gpp�ICATION FOR SANITATION PERMIT -'E - �c3 p � Permit No. -/,- - -=----- ------ l _ , w o tx .(Complete in Tri hcatel issue, Date issued --------------- --�- ------ p - This Permit Expires 1 Year From Date d ---------------- ----------------------- ----- ------ This Wal rict it construct and e work here' Application is hereby made to a San JoaG compliance with CF=17 in ounty tO Ordinance a Nom549oand existing Rules, and hRegulat ons- PI is ade p ( � 4e TRACT described. This app a.!! (t JOB A � '-r 7 1 ,DD9.ESS/LOCATI NF._ ,v r - one ------------------------------------ %. Owner's_ 'Name -.-------1 1- -A-- / - -- -P�.-- ------------ -- ------------------ ------ Ph- Ci#Address ------' Phone Y Contractor's Name -------------------------------------------- Installation ----------- -- ------- ---------- --- - -- ----------- F Installation will serve: ` Residence rnent House'El Commercial FlTroiler Court E Motel ❑Other -- ------ ------------- II , ' ---- Number of living unit':_. 1.-.... Number of bedrooms _i----Garbage Grinder, _ . - Lot Size Water Supply: Public System and name -------------------------- -- --- -- Private ---- Character of soil to a depth of 3 feet: Sand'❑ Silt ElClay Peat El Sandy Loam Clay Loam `J Adobe Fill Ma i Hard pan terial If yes,type -- lls, �^ i , � (Plot plan, showing size of lot, location otAystem in relation to we buildings, etc. must be placed on reverse side.) ' NEW INSTALLATION: k (No septic tank or seepage pit permitted if public sewer is available within 200 feet) P / % lr (f � � ------N----- Liquid Depth PACKAGE TREATMENT. SEPTIC TANK o. Compartments ts ....... � ----• Capacity ----- TYpe Material = �. aa" E I - Foundation �-- -- ----- Prop. Line - ----------- . , nearest: Well ___vQ----�----------- Distance to er 1 h Length of each line---- - 1---- ----- Total Length _ :- -•=-=-------- \ ir LEACHING LINE.--E -• No. of'Lines -_ - -------------- tF E �� ept r Y ! y: � h Filter Material _ f D' Box L.r�-- T pe Filter Material i �- Foundation l ��--- Property Line �. Distance to nearest: Well _---� - 9__1T0_0� )rj �. ______________ Rock Filled Yes 9_ FVV 0 SEEPAGE PIT [ p t f Diameter __ sg_-_=Y_-Number ---- ' l I ---Rock Size ��2-- - I i�*A Water Table Depth ----- - -- ------------�-------- v -------------- Water f - ____-_Foundation __ - p. Distance to nearest: Well ._�0----------------- -- f1 Pro Line --- --------------- • ------- - -----�'� Date ------•-----------•---------------} ! �> REPAIRfADDITION(Prov:San Sanitation Permit# -•-----}--- --------- REPAIR/ --------- -_ -------------------------------------------------------- -------------------------------------------------- +- -------- . Septic Tank (Specify Requirements) ---------------------------------------- - 11.Disposal Field (Specify Requirements) ----------------------- -----•-----I--------- v .v "w..`.i = ------------------- --- ------- ------------------ ---------------------- 4 ------------ - I--------------------- ----------------- ----------------------- ----------------------- (Draw existing and required addition on reverse side) 1 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: t "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." P 1 Owner Signed - ----------- ----- ---- = ---- --------------------. Title ----------------------- - ot r than owner) i So FOR DEPARTMENT USE ONLY i DATE -_� _-r'- 1 J �6-- APPLICATION ACCEPTED BY I -��'i0 -------- - - --- DATE _._ -------- - BUILDING PERMIT ISSUED --------------------------- ADDITIONAL COMMENTS ------------------------ - � - ------- ---------------------------------------------------- - J._ ----------------- ------- ------------------------------------------- ------------------------------ ------------------------------ - ------ --- _ Date _. Final Inspection b ---- - - ------ N JOAQUI ' LOCAL 4ALTH DISTRICT t - E. H. 9 i-'68 Rev. 5M t