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APPLICATION FOR SANITATION PERMIT }} C USE: Permit No. .7 :•5`�d I (Complete in Triplicate) "^',. Date Issued ................:... 11_�' This Permit Expires 1 Year From Date Issued ; •-------- . cation is hereby m de to the San Joaquin Local,., f0r...a permit to construct-and install the work herein ribed. This application is made iri compliance with` County Ordinance'�IVo. 5Q9 arir!existing`Rules and Regulations: r ._. ( NSUS TRACT ....... /Owner's ADDRESS/LOCATION ..... r.... — --- - Phon - 4Y.`, �. .:'' r,:-�.. .... a ....... Name . . � i. .•-—5-- ...... �1 i /:.. f - C.� �._.-._.--..:.:.:.....:_ -•--••City =/�tzfO .........:: ..:::.:.::..........a......_..... Address . �l _. ._ . - _ , -... Contractor's Name ..........er ` � /�.r ................................ License # -� -•- Phone installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court ❑ Motel ❑Other ..__. .............. .•----•... . - -�.._ ......._.. r V.. Lot Size C'.� c,' Number of living units:---/..--. Number of,bedrooms _��_...Gari�age Grinder / � , Private -�- -- to Public-Systemand-name•'-"7n w_... ,.".: .._............ :_x P Water Supply- J__ Clay Loam f L Character of soil too depth of 3 feet:; Sand O .Silt❑ CIaY ❑ Peat❑ Sandy Loam ❑ Y i Hardpan ❑ Adobe.E] Fill Material ............ if yes,type ........------ •--...._......' ton of..system-in-relation-to wells, buildings,tett. must be placed on rever I (Plot pian, showing size of lot, Iocatse side.} Q ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, SEPTIC TANK�[ ] Size............................................. ... Liquid Depth PACKAGE TREATMENT, [ 7 No. Compartments FMaterial - Capacity Type ----•-----.....------ Prop. Line---... ................. -_ .. ----•--o---- Distance to nearest: Well ----- ------------------------------Foundation..._..-----....----••- € . Length of each line----------........:-••--•.... Total Length _-.-----•••••--•••-- ------ LEACHING LINE [ j No. of Lines ..--_---•-------•.. g ......Depth Filter Material ................ . . ....................... ',. 'D' Box _._._...___. Type Filter Material } . Foundation .................:n. Property Line .......-................ � Distance to nearest: Well ....................... •-- -thy -------- Diameter ................ Number .---- -• -------------- Rock Filled Yes No (] SEEPAGE PITT["') []"� -1)6-pithy------•�---- --- Water Table Depth -_......Rock Size -------•----•-•---•---••----•-• Distance to nearest: Well--._...:'--•-.............------....... Foundation ... Prop. Line ...................... ...__...._:) REPAIR/ADDITION(Prev. Sanitation Permit# ...................................... Date . -• •--- .•.... ....... ----- -. Septic Tank (Specify Requirements) ------------------ 10 - Disposal Field (Specify Requirements) -- •••-- , , _. -----------------------------------••---•-••--------•--- ---- --------••- _ ................. ...----....... _..._.. (Draw existing and required addition on reverse si el I hereby certify that I have prepared this application and that--the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District Home owner or licera sed agents signature certifies the following: ermit is issued, i shall not employ any person in such manner "I certify that in the performance of the work for which this p as to become subject to Workman's Compensation laws of California. z Signed ----------- ----•-.... Owner - title $• *9 •- BY .................. ..• ad s I (If of an owner) FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY .... ..... .. .. .. ..... DATE _./_ ._l ?_ ........., ....--•--••--DATE _..._..._....---............_......_r BUILDING PERMIT ISSUED .................•••. ... ..................._.........................................................................---------------•-.. ADDITIONAL COMMENTS ......... . .... .._.�....._ --.... ..... .... • ....................... ----•- � f...'. _ . ....:. Dater Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT ' . 7172 _ .. 11 214 , 1,L0 Ds., +SAA -