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rWK urrit-t me. ` APPLICATION FOR SANITATION PERMIT (Complete in Triplicate} Permit No: ""'..............•.•..... p This Permit Expires 1�Year From Date issued� � Date Issued . // f�=.7,5 Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliance w' h County Ordinan No. 54�fand eVngUSes and Regulations: IV JOS ADDRESS/LOCA ION . a .. ... W ._ .. .--... TRACT Owner's Name I ..... .� ...�. Address •e. _.Phone fT�..._..... �j f3 ,: rz� II -�* --------------- ...... Contractor's Name ••-<--�,-,.. •.f11.�1�5' _--�`. . ...._. ,1i` ....... .............. Phone .2.4-p60 Installation will serve: "-"' """•'•- Residence)<Apartment House Commercial oTrailer Court Motel ❑Other _...........:_._..... Number of living units.............. Number of bedroomsGnrba Grinder ;. .... ._.-_. Lot Size .. Water Supply,,Public System:and name .......... .. J..`..7L.... ..... ag 8 . ................................ ...........Private ' Character of soli-to a depth of 3 feet: Sand 511t Clay ij: ❑ Y ❑ Peat❑ Sandy Loor if Clay_ Loam Q Hardpan❑ Adobe❑ Fill Material ............ If yes,type (Plot .plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No.septic tank or see a e . it ermitted 1f public sewer is available within 200 feet) p: g P' p PACKAGE TREATMENT ' ( ] :, SEPTIC TANK } Size................................................ Liquid Depth Capacity ................... Type Material............ . No., Comp rtments _ Distance to nearest: Well - • ......:......•-----•-•-••-•-..---...Foundation ---....... _ _...�_ Prop. Line . ' d LEACHING LINE � -1••••......:........,� [ j No. of Lines Length of each line................:... Total Length 'D' Box ....`•-----• Type Filter Material ...................... .... T ..._ .i............ ,.� .............. 11i---.......Depth Filter Material.........................................� 11 ... . :... Distance to nearest: Well Foundation ......_. Property Line i ................. SEEPAGE PITS' [ 1 ' E .�i Depth -----.._..-----:.... Diameter Number Rock Filled Yes CE] No C) Water Table Depth ' Rack Size � Distance to nearest Well ......-• .............................Foundation .. Prop. 't Line ....::................ � REPAIR/ADDITION(Prev. Sanitation Permit .......... ::... - w ---- --- D to - Se tic Tank (Specify Requirements) I p ( eci Re uirements _'�_ ... .. Disposal Field (S city Requirements) _ •� �• •...9.. , ..... `� III 3 ....... ...... ...._.._.........._........_.._...._........ .............. .._......... _ ....._,... . ------------ ........ . _....::..::.... (Draw existing required addition on reverse side) ... .... 'and .. - I hereby certify that I have prepared this application and that the work will be done in accordance with Satz Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. sed agents signature certifies the fallowing: , "I certify that in the performance of the work for which this permit Is Issued, I shall not employ an os to b )me ubje o rkmpn's Compe aws of California." p y y person in s Ich manner Signed . A_ ._ By ............... .. ......................----••- ( t st.,/ title ._.. .. - I . (I other than owner) ..........................--- -^ _ mm_ FOIL DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY •. ..._- BUILDING PERMIT ISSUED ._.. DATE ...... .......... ........---------- --- --• .DATE ..........................ADDITIONAL COMMENTS . . ................................. ------------------ ........................... -I.---------............................................................ ........................................ ...... -------- - . ...... :I ............. .... Fina# Inspection by: ._.....-•----•......-•................................... ........---• �1 _. . . _. _Date ....... ......... .. N JOAQUIN LOCAL HEALTH DISTRICT