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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .7.Z. Permit No. . .. • lcomplete in Triplicate) R t Date Issued ..�1.. 3-xY This Permit Expires 'I Year From Date issued land Apptication is hereby made to the San Joaquin Lcompliancocol e wiHh Counealth DtytOrdinarict rn s per. it and axismy Rules tand Regulations: f7 described. This application is made P ,� / !CEN US TRACT ...............:......... O JOB ADDRESS/LOCATION .<.7.. �< - ___ _ _ " Phon y Owner' .........:......... ......... ..~V)' . .�....��.r.�= .Q.c�,�•;111 /',�f� city _. ... .. ........................... _ .. { Address f e Phone . .._ ... ... ... � Contractor's Name � •• I Installation will serve:�� Residence ❑Apartment House�] Commercial„®Tra}ler Court Motel ❑Other ._r............. .......................... f Number of living units:............ Number of bedrooms -•--•• Garbage Grinder /.YL.!._. Lot Size `f.♦` : ° _.... Peat .....�nd --Loam ❑ ... y J Private � Water Supply: Public System and dame ....................•......._..... I Character of soil to a depth of 3 feet: Sand ] Slit Q Clay ❑ ❑ y Clo Loam -.� Fill Material • ' Hardpan [� Adobe, ] ...... ..... If yes,type ..... ................ Plot lan, showing size of lot, location of. system in relation=t&Wells, build;r+gs,, etc. must be placed on reverse side`.? { i' NEW:INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, P i 1 �...��... q _ SEPTIC-TANK Size.�� --•- - .. ...... Liquid Depth ........................:- PACKAGE TREATMENT [ ] � � k -,• 3 , . Materiae l No. compartments Capacity/ 4.......... Type . .......... t l ..Foundation /� ... Prop. Line . .. Distance to nearest: Wali �...,tf�O-.-•---••-•••-•••• f i f .. Total Length ....•..........=. [ No. of Lli es .._ Length of each iine...l. 0...- g LEACHING LINE ...... /-....Depth Filter Material ..... .................. D' Box /� Type Filter= Material . -. PY Foundation F' Distance to nearest: Well ..�-Q�•••--••`� ,. �.�._.......... Property Line Y k • . Number .....-:....._._...:. ills es No 4,: Rock . � ❑ ..... Depth _.. . Diameter s3 ...._.. '/ /� !,,SEEPAGE?lT [ P l t Water Table- Depth .c ( ... ...............:..._...............:Rock3ize��2..__ /.............. f F : ........... 4 Foundation .. ............ Prop. Line . ...............• Distance to nearest: Well ... --. -...1 ...... y f REPAIR/ADDITION(Frau. Sanitation Permit# ............................................ Date . Septic Tank {Specify Requireme ............I............................................ ,. :Disposal Field (Specify Re quirementsl ................................. I ........ ........................................................ . .:....-.......... ... _.............._....... .... k ............. . ........ xi e {Draw x;stin and re ulred addition on reverse side) cern that I have prepared this application and that the work will be dons in accordance rnr o Son o��teen� 1 hereby certify County Ordinances, State Lawn and Rules and Regulations of the San 'Joaquin Local Health District I sed agents signature certifies the following: "i certify that in the performance of the work for which this permit Is issued, 1 shall not employ any person in such manner f as to become subject to Workman's tom onsat)on laws of California." e ................ Owner Signed ...... By.............. - - ..... Title .. ........:..... .... . . .... {1f of�e hen own , . FOR DEPARTMENT USE ON Y p� ? DATE ..t..�... ,,7 • ... . 7.. APPLICATION ACCEPTED BY ...�... ..• -•••••--• DATE BUILDING PERMIT ISSUED ADDITIONAL COMMENTS •............................................................... ......................... ............... _.. - ....._. : .. .....:......... .... :.....Date .... �:, .,y ..i .. i Ins ection b ; ........ .. •••�Fina p y ..... .. ��- 1 , SAN iOAQUIN t AL' HEALTH..DI5TRiCT -- 2 3 24, .ao n_-, Gu►