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FOR OFFICE SE: APPLICATION FOR SANITATION PERMIT Permit Nora-- -- �� /3.76----------- - (Complete in Triplicate) - ------------ This Permit Expires 1 Year From Date Issue -- Date Issued _�� --------------------------------------------------------- e work Apprcb0e on is hereby maoeis°madeSan in compliance with Health CounDistrict O dingn a permit and existing Ru�estand hRegulgtions�e1n described. This applica 2 ✓ 46,= CENSUS TRACT -------------------------- - - Com-------- ----- JOB ADDRESS/LO TION ---- -------------- - �7 j ------.-- _ hone _- _ _b - __ -___ Owner's Name --_ 1 i _ city __ __ ___ _ __ _ ____ _;;_ . --- -- - - _---_•---------- - Address - ---- -�---- ------ ----- -:. , � -- one ---- - -------------License # Ph � Contractor's Name ____-----_-- - - -- - - -- -.,�._,__:_... . F�� t " Installation will serve: Residence Apartment House❑ Commercial []Trailer Court `❑ d. i jMotel ❑Other ------------------------------ Number of living units:----t -- -- Number of bedrooms _01-- -=--Garbage Grinder- __,__-___ Lot Size ------ f j ------- ------Private Water Supply: Public System and name ____________________________________ Peat Sand Loam ,❑ Ciay Loam :❑ i Character of soil to a depth of 3 feet. Sand'] Silt❑ Clay ❑ ❑ Y Yes, e ---------------------------- Hardpan ❑ Adobe'�Fill Material _-___-_-_-- I es,typ I . buildings,` etc. must be placed on reverse side.) (Plot plan, showing size of,lot; location of system in relation to wells, I I NEW INSTALLATION ,{.No:septic tank or seepage pit permitted if public sewer is available within 200 eet, -A*�.� t PACKAGE TREATMENT { ]�'_�SEPTIC TANK:[ ] Size------------------ Liquid Depth ---------------- S-, i `' � Type Mgterial ------ No. Compartments ---------------- 'Capacity -------- �.I Yp l F , �^"" `Distance.to nearest: Well sof a--)i� Foundation ---------------------- Prop. Line .-__------ ;: � r , ..';s ----•--------------------- Length e------------ -- --- ---- Total Length -- LEACHING LINE," [ l No. of Lines -------------- --------- s ar �t 'D' Box ---- ------- Type Filter Material --------------------Depth Filter Material - 71f _ --_______ Foundation - � Property tine ------------------------ Distance to nearest: We -------------- --- -------------------- � � � Rock Filled Yes ❑ Na '��-•-._ SEEPAGE PIT Ll ,./. Depth D�iameter„�.:::----_-_ :Number __ :: :.:._ ��— Rock Size -------------- -------- N ` �Watar'Table Depth ----------------------------- -___-.Foundation _ Prop. Line ------------ --------- Distance to nearest: We -------------------------------- s I ------- Date ------------------••------- ------ REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------- ---- - ------ [Septic Tank (Specify Requirements) ---------------------------- f Disposal Field (Specify `Requirements) --- --- r. � --- --r-r---- _.---- ---- _ '- --�------------------------------------------------ i - - - I (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 j County Ordinanies, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- f —.—sed agents signature certifies the followings' "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed r=►=' - '-- . ,Owner , P.iw r ' --- . Title- --=------ -------- -- Y - ---------- (Ifo er t n caner) _ � fi i R DEPARfMENT USE ONLY DATE �' "? ----------------- % at APPLICATION ACCEPTED BY -------- - ---------- - -91-P- .._.--------- -------- DATE - ---- -- - BUILDING PERMIT ISSUED ----------------------- ----------------------------------------=--- ADDITiONAL COMMENTS ------------------------------------------------------------ ---------------------------------------------------------------------------------- - --------------------------------------------------- -- - - �_=1 � �• ! --•--------------------------------------- Date --- Final Inspection b - - -------'----------------------------------------------- SAN ---- F SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M