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_-�- •' - FOR"OFFICE-USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.t1_-.._------�- - (Complete in Triplicate) ------------- _3 � Date lssued._�f.------`-- Is- This Permit Expires 1 Year From Date Issues) .... ' a � , I and Regulations; } is hereby made to.the San Joaquin Local Health District5oorr aanpdere t ngconstruct rind install the work herein describe Application Y This application is made in compliance with County Ordina ce No .......CENSUS TRACT. JOB ADDRESS/LOC T10N.------ -`' r �' ?,; --.Phone.. i . ---...... --- Owner's Nome...... p .:. Cit *._.. Address----------5- - //'J Phone _ License #- a� l ?33 i Contractor's.Name---. -- -- Commercial El Court [Ir Residence Apartment House Elknsfallation will serve: '- # t MLI [] Ofher...._ ------ -------- J -- - -�-� .. �-- -- y 'V. J - g -- ,er of bedrooms_;.'"sj.., .Ggrbage Gr�nde•.r- _Lot Size_._-- -- � -------3-- Private Number of living units:...-�- ....- �, �! 9 /- Numb L . Water Supply: Public System and name ..... .......... .•--- ------ ---... Clay Loam Y y [� Peat ❑ Sandy Loam ❑ Y b p Sand ❑ Silt❑ Clay Character of soil to a depth o feet; -_-. I Hardpan ❑ .� Adobe ❑ Fill Material...-_ _..Jf yes, type-- -•---------- Plot Ian, showing size of loft, location of system in relation'to wells buildings, etc. must be placed on reverse side.) € P e^ it pe if Public sewer is avaiiable within 200 feet,) Q F � r `� NEW INSTALLATION, (No septic tank or seepag p p ^ -Liquid Depth--- ------ --------- 1 Size._ + X, .�G� = ANK [ 1 PACKAGE TREATMENT [ l } SEPTIC T , Material_ . Na. Compartments...:. Capacity J ' ':SYS+'+ Pro Line_._._{ .._.. . ... { Distance to nearest: Well--- -.'- _Foundation.:- .� p �... ,,. ._ .. . Q...--------- .Total Length k No. of Lines :_. �-- .--::--" Length of each line--- - LEACHING LINE I ' }. P De th Filter Material_. ._ .- l 'D' Box ype Filter Material--.�.. / - - Foundation-- -.... ----•�----��--:--:-Property Line---------------- ----- ---- --- -,- Distant to nearest: Wel(= ` Rock Filled Yes No ❑ �'..Diameter ---Number.-�--' --------- ------------ I SEEPAGE PIT [ .] Depth.. .. Rock Size._.. . / f Water Table Depth .....Pro Foundation_.----- p. Line to nearest: Well-------- -�-�� -- ----------------------- Distance ' i ' � ---- ---- -- � • - �--- ------Date-------------- ---- ..._. ---- ----- - - REPAIR/ADDITION (Prev. Sanitation {Permit#--------- Se tic Tank (Specify Requirements). ----------------- --- .--- -- y l p p �.,.. --------------- --- Disposal Field (Specify Requirement)-- - -- ....... - .._ . -------- -� ----- �- (Draw existing and required addition on reverse side) uin Countt San Joaquin Local Health District. Ho Ordinances, State Laws, and Rume owner or licensed agent I hereby certify that I have prepay�d this application and fh�e tthe work will be done in accordance with San Joaq les and Regulations of t signature certifies the following: person in such manner a certify that in the performance.of the work for which this permit is issued, 1 shalt not employ ant "IfY ensation laws of Califor its." to become subject to Warkrr±an's' Owner .. t Signed - Title... ....-.-- (lf o er t an owner) FOR DEPARTMENT USE ONLY DATE , ACCEPTED BY APPLICATION __. .....DATE------- ------- --- -- DIVISION OF LAND NUMBER ................ . ---- ADDITIONAL COMMENTS ij I _. .......... ` D ... ---- ---- ------=------•----- Date........ .. ----------- EK ----- --- --...------ � �- -------------•-�-�- ----•......._._ --� S 2�� REV. 7 l Final Inspection by:.------- :' IXJ� AN JOAQUIN LOCAL HEALTH DISTRICT y i EH t3 24 � .�