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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT Permit No. .7 _ .- - (complete in Triplicate) ....4_.._....._... ................................... Date Issued ....."...._:....� ........................................................ -+ This Permit Expires 1 Year From Date Issued f l the work Application is hereby made to the San Joaquin LocaNHleC�District rnce permit and existing Rulestalnd Regulatlonsrein described: This application is made in compliance ..„_ ,. G ... /.. _.-......CENSUS TRACT .................. JOB ADDRESS/LOCATION'/_4e-.4F;_ ............. _ ._ .. .frrt2.. :-- •............:. Phone Owner's Name .�-t�..:��.`� .--- -- I'h ...•y �; . ...:........................... I , P Address S -�,.iC'�.... Phone k. 5'~'. Contractor's Name . ti-r*�� 'L� . .......................License # ._ ..._..:•- Instollation will serve: Residence Apartment HouseO Commercial ❑Trailer Court ❑ ! Motel ❑Other .......................... Number of living units.-........... Number of bedrooms ............Garbage Grinder .......:.... Lot Size ..:...__.__....--- -••-••-- -•--•- Water Supply: Public System and name Private ❑ me ......................................................_----....------•---- ... Peat Sand loam ❑ Clay Loam ❑ Character of sol! to a depth of 3 feet: Sand El Silt❑ Clay ❑ ❑ y "fHardpan Adobe'❑ Fill Material ............ If yes,type ................ ........... . ❑ k (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) it errnitted if public sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or seepage p' p SEPTIC TANK [ ] Size.. -••----” •::..................•...._ Liquid Depth .....-..............-..... PACKAGE TREATMENT [ � � r No. Compartments Capacity .................... Ype -••-•---•••• - Material................ .........-- 6 Pro line 1. Distance to nearest: Well -------------- ---- __Foundation P• •-•-•-•--"""`•""' LEACHING LINE ] No. of lines ....-- .•-•---• Length of each line......... ........ Total Length Depth Filter Material ....-----:•-•-• IM ----.....••....... ...... 4 'D' Box -- Type FilterNMaterial ................... p _. Foundation Property Line ..:........:............ Distance to nearest: Wel) ----------- ---•---._ �-----••--- •--...------ SEEPAGE PIT [ ] Depth Diameter .... Number •• -_..... Rock Filled Yes ❑ No (:I ...Rock Size Water Table Depth _....Foundation ..-. Prop. Line ----_-------••---.---- Distaste to nearest: Well '--•""'--'"-'-" v.�n. fe. .Date� REPAIR/ADDITION Prev. Sanitation Permit Septic Tank (Specify Requirements) ....... . ...............4- ..........................................w.......---.._..._..................._.................... 9 Disposal Field (Specify Requirements) .. - -- -- . ................:.........r".� .................. -....... ........................ *.... °= - -----------------•------ - - (prow existing and required addition on rhvers,.�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 Jonquin'local District' I I. 0 wn� or licen- sed agents signature certifies the following- "! certify that in the performance of the work for which this-per!nit is iss+wed,Vihall not employ any person In such manner as to be ome subject to Wo kma=apnsd�i .r Cali#ornia."Signed - •----- --------`�-•----------..._. -------- - Owner __. Title ..................................• ..._..__....__.......----....._ By ..................(If other than owner) f FO DEPARTMENT USE ONLY ` r --------•--- s - !o .--•• . .. ------•-----•----- •---•................. DATE APPLICATION ACCEPTED B .. --.--••.- ----• _ DATE ............ .......... PERMIT 1551IED ............... I-... -------------•-- •. .. . ADDITIONAL COMMENTS ............................... ...... .................................. _ •. •.. ...... ... ... ----•-.. --•---••-•-•----••••...•---'Date .. J y.... Final Inspection by: ✓"�.._.....-•-- . ........ .. ................ . YSAN..JbAQ� UIW LOCAL'. HEALTH DISTRICT _.� _. . .� _ .