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t s FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � ��, JJJ))) Permit No. .-7L=-G-d_~'�-- ' .- .--.._...... -- -- �f (Complete in Triplicate) Date Issued - I/�+ This Permit Expires 1 Year From Date Issued id l the work Application is herebymade to the Joaquin compliance Local Heith lth District ordinance rpermit t and existing Rulestalnd Regulations!or described. This app ' / �l A� _ ]OOtl ON N. �A. :... .. -K f� --------------------- Address - - - - IuI . ...CENSUS TR - ..._..>�.�--- J08 ADDRESS/LOCATION ..��7r//1--- Phone --.....""......."------------------- Owner's Name ......... �iQt-- _. -!✓! {_-7---................... ....... k- O- V b Address --..- '- - `- ��ffiT.._•..�- -�--'----------.. .....:........License# .y'�Qi .j.----- Phone -- ---- --...". t� Contractor's Name ..".�A- - Installation Residence I-1ApartmentHouse's Commercial Trailer Court will serve: Motel []Other...5-00f-- ..".."................... Number of living units:..."..._.... Number of bedrooms .._...__"_-Garbage Grinder _-- --- Lot Size ---- - ' '"---------. Private - - -'- -- - Water Supply: Public System and name ."--------------------------- Peat 'Cloy Loam 0 I Sandy Loam I]. Character of soil to a depth of 3 feet: Sand' Silt❑ Clay❑ y iHardpan❑ Adobe o Fill Material ............ If es,type \ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or seepage pit permitted ifpublic sewer is available within 200 feet, tr Q PACKAGE TREATMENT I I SEPTIC TANK Size..' ....-- " -------------- Liquid Depth-5.."..".................. No. Comp _ - ........... Capacity(�V.- ------ TYPe 9- �- - Material artments - - -- Foundation 1 D.------------" Prop. Line . .. ....�........ istancel to nearest: Well 10.0110------ ��,,,,nn r j "�"..."..""_". Length of each line._ /- -- --- Total Length .�.r(...--------- LEACHING LINE [ No. of Lines C . d- 'D' Box I". --- TYPe Filter MaterialJ' QGcar---Depth Filter Material .-. --- -- -- ................... - --- - -' 2 t7 Property [ t Line _�. ----------•---- Distance to nearest: Well .�_Q - ---------_ Foundation "......__._"." I -----_------._. Number __.--------------- --- Rock Filled Yes No p i SEEPAGE PIT [ ) Depth t Diameter Water Table Depth Rock Size ..._"_.".. ---------------- \ •---_~.._._Foundation Prop. Line -------------------".- i Distance to nearest:Well _....:-----------------.... O I Date --:--- r ................ REPAIR/ADDITION(Prev. Sanitah.on,Permit ---------. ...'- Septic Tank (Specify Requirements) --------------------------- Disposal Field (Specify Requirements)4 - ` ----------.. ---... ....................... -" ------'- - .-.."..._ (Draw existing and required addition on 'reverse side) rk will be done in accordance with San Joaquin I hereby certify that I have prepared this application and that the wo County Ordinances, State Laws, and'Rules and'Regulations of the San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance f the work for which this permit is issued, I shall not employ any person in suc m°^nor as To becometub to Workma s Com ton laws of California."___ Owner Signed ...- - -- ---- - - - -. -= -- Title - - .. .. -- - -- -. .."r than ow;er) FOR DEPARTMENT USE ONLY _Z I APPLICATION ACCEPTED BY_".T. '- - --.._..._---- DATE ----- DATE BUILDING PERMIT ISSUED--------------------- --- ..... -- ..........--- - -------------._._................"- - --- I ADDITIONAL COMMENTS _."--- - ----------------- - - q - - - - ... --------------------------------------------- _.." T --............._------..... -- ------------- - -- - - "_. ------ -.."_...- Date -"...---- ---- - - ------- -- .. - - - _.....-"- ------_Da Final Inspection y; ..---. - -- -`- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M