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FdR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _�-� -��-•--`f--p ---------------- --------- (Complete in Triplicate) f Date issued ___ _________ __ _ _------/�-�-� ---------------- This Permit Expires 1 Year From Date Issued - --- -- l the work rict for ct it to cons u Application is hereby made to the San room Ilan compliance withealth CountytOrdi once Nom549 and existing Rules tand Regulations re+n described. This application is made p CENSUS TRACT -----------------•-----•-- JOB ADDRESS/LOCATION�.__ M50------ r-- ----- p / Phone 7 -7 7 Owner's Name U - --------- - ---- ----------------- _(3 � city ----------- -------- -------- ---------------------------41147 racto--s Name --.-.1= � _.License # -10,5 ----- Phone •--•---• -- Address _ _----_-- - //- Cont Installation will serve: Residence Apartment Hous P( ❑Trader Court 0 Motel ❑Other .------------------------------------------- Number of living units:--- ----- Number of bedrooms _--�3-----Garbage Grinder ------------ Lot Size ---- private Water Supply: Public System and name ------------------------------------ - _ -Character of.soiI to a depth of 3 feet:.. Sand'❑ Silt{] Clay 71 _`Peat❑ Sandy Loom :E] Clay Loam ❑ � -� ~ Hardpan 1K Adobe IC 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 seepage pit permitted if public sewer is available within 200 feet) f PACKAGE TREATMENT ( ] SEPTIC TANK S• e-----J----x-`�----------------------------- Liquid Depth�. ---------------.----- ---_ No. Compartments _��--------••-•- Capacity�7 - `'�- Type - -------- - --- Material(_:P C�' P Distance to nearest: Well --------�(1-- --------------Foundation ----/V--------- -- Prop. Line _-- ------..r----•-- � ____ Total Length LEACHING LINE No. of Lines -------117 Length of each line-___/_ ------ 'D' Box -----✓ Type Filter Material ------Depth Filter Materiai .--------�--� I Distance to nearest: Well _-- --�`--��- Foundation ._____l.Q__._'t-__.__ Property Line ___`.7----------- ---•-- _____ Diameter - 3 - Number -......... t------------ Rock Filled Yes'` No i❑ SEEPAGE PIT [� Depth _- ---- - 1 / ,� P --------------------------------------------- -Rock Size �` Water Table Depth �, Foundation ------------ REPAIR/ADDITION ---l -- Prop. Line _.. ------------- D'++stance to nearest, Well -------/_60------------------------- . . • ----------- Date -- ----------------------•--------1 -- -------- RI?PAIR/AQDITION(Prev. Sanitation Permit ------------ ------- - -- Septic Tank (Specify Requirements) _--------------- --- ---------------------------- Disposal Field (Specify Requirements -------------------------------------------- --- ------=------------ ----------------------------------------------------------------- ------------------- r------------- h__„ T_ _ ` -------- ---- - - - - - - ----------------- t an - --------------------------- - [Draw existing and re uired•addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with 5 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 following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." - Signed ----------------- -------- ------------ ---------M---------------- Owner Title ------- [If than owner o-FFOR DEPARTMENT USE ONLY DATE ct` -. ti'-" * ------- APPLICATION ACCEPTED BY 7 - -- ---------- ------- DAT BUILDING PERMIT ISSUED -------------------------------------------------------- ------------------------------------------------ ADDITIONAL COMMENTS --------------------------------------------------------------------------- ---------------------------------------------------- --------------------------- _________________________________________________ ___-____-________�____ ____ ________--- _3.._____ _ -------------- t � - �___ -_.___ _ --------------- -1 --- .Dater.--� ------- _ _ ---------------------- Final Inspection bY ----------------------= SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M