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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / S � �. i7 Permit No _ ----- ---�G"-- ------------ r (Complete in Triplicate) Date issued _77-k --'--'---.,..----- - This Permit Expires l Year From Date Issued e work it to construct and insta Application is hereby.made to the San Joaquin c wltfh Health byt0rd Ordinance a rict for a Nom549 and ex st ng RuEes,�a'nd hReyulationsrein described. This application ;s made �n - --CENSUStAC.T_ :F:,,_...:.- JOB ADDRESS/LOCA ]ON Pone ------------------------------------ Owner's Name ---- ----------------------•-------- Address -_� 7 f -� D .License# �I .E Phone Contractor's Name --- Installation will serve: Residence Apartment House❑ Commercial :j]Trailer Court ❑ Motel ❑Other -------------- ----------------------- / Garbage G�inder� Lot Size _./-V�-4-�--d ............. Number of bedrooms � ----- �----- Number of living units..---/--- Private E Water Supply: Public System and name ---------------------- --- Sandy Loam ❑ Clay-Loom:[I Character of soil to a depth of 3 feet: Sand'❑ Silt F] Clay ❑ Peat F1Hardpan E] Adobe' Fill Material ------------ If yes,type st be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mu No septic tank or seepage pit permitted if public sewer is available within 200 feet,) k NEW INSTALLATION. l ` PACKAGE TREATMENT [ ] SEPTIC TANK�[ ] Size--------------------------------== ------------- Liquid Depth -------------•----- y,'' ----- Materia{-------- ------ ---- No. Compartmentsartments -------------•--- Capacity --- ------ -- ---- Type---------------Distance to nearest: Well ------------------------------------Foundation ------ - ---- ---- ----------------Foundation ----------:------ ----.Prop. Line ._.__..__.,-----•----- -- Len th of each line------------ -------- Total Length -------------•-------------- LEACHING LINE [ ] No. of Lines --------- ---------- g ------ 'D' Box ------------ Type Filter Material ----------------- -Depth Filter Material -------------------- --------- ------------- Distance to nearest: Well ------------------------ Foundation ------------------------- Property Line --•-----••---------_-- SEEPAGE PIT [ 1 Depth ------- -'- Diameter ---------------- Number . -- ---------- -------- Rock Filled Yes '❑ No 1❑ Water Table Depth ---------------------------------------- Rock Size f --- Prop. Line .... Distance to nearest: Well ----------------------------------"--••-Foundation ---____-- -- Date ----------------------------------1 i REPAIR/ADDITION(Prev. Sanitation Permit# -•-•----- µ - - --------------- -- Septic Tank (Specify Requirements) .___-------"----- - - -- Disposal Field (Specify Requirements) _- - -44 - ---moi ( � .. --- . ------------------------ - -------------------------- ------- ------- ------ - �J --- - - t C1 v`t - r� f" Draw a istin and required addition n reverse si e h Son Joaqui I hereby certify that I have prepared this application fic sthat the San Joaquin Local Health D strk will be do'ne in ridctnce t Homeowner or !cenn County ordinances, State Laws, and Rules and Reg la sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p I as to bef e.s b'e to W rkm 's Compensati aws of California." pop Owner Signed - - --------- ---- ------- 6 r- ------ - Title '----- ----- ------- - i y I (if other than owner) v �I)EpA1�TMENT USE ONLY DATE ._---�_'"rLT.�] ------•--------- APPLICATION ACCEPTED BY --- ----- ------ - ------•-------- BUILDING PERMIT ISSUED --------------------------------------------" DAT i. ADDITIONAL COMMENTS ----------------------------------------- r --------------------------------------------------------------- -------------- - - - --- ' ► '� ------------------ - - ------------------- -------------------------- ----- ------------------ Date � -- -------------------- - Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M