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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- - --------- ------------------------ (Complete in Triplicate) ` ------------------------ ------- Date Issued . --------- This Permit Expires 1 Year From Date Issu- s e work rein Application is hereby made to the ean compliance ec l Health lth Di tri rdinan e ct for a erm549 and exist ing Rules to construct and tand hRegulat ons.. described. This application s A p c ountyq s -� CENSUS TRACT JOB ADDRESS/LOC ON Phone ------------------•--------- Owner's Name --- - _,_. _- - w I 1 Address - �� ----�--�- �- city - 'License # --- -- --- ---- -- Phone ------------------------------ Contractor's ----------------•---•------Contractor s Name { ResidenceA)(Apartment Hou �[] Commercial ❑Trailer Court i❑ Installation will serve: I p ) E Motel ❑ Other ---- --- -------------------- __.__Ga b g�Gi __ -Q--- Lot Size Aa Number of living units:_.___.____- Number ofdraos ❑�"�------ ------------------ ---------Private Water Supply: Public System and name ___S -_ Clay Loam ❑ Character of soil to a depth of 3 feet: . Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Y f I Hardpan E] Adobe X Fill A ciferial - --- if yes, type ----------------------- --- A (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} ` r p seepage pit permitted if public sewer is available within 2Q0 feet,) NEW INSTALLATION: (No septi tank or / !��?C � `�c_._� - ------------ Liquid Depth ----- ----------- G PACKAGE TREATMENT [ ] SEPTIC TANK'X Size.. ----_ __- .__- _ ' Capacity -0Type Ll Q. --_____ MaterialO��----- No. Compartments ___ c------------- Distance{ to nearest: 'Well ------------------------------------Foundation --_------------- I'--- Prop. Line -------'-'.-.---r----- Length.of each line.---f -- ------------- Total Length ----- Q ......... LEACHING LINE �, No. of Lines _-�----------- - g _. 1 *r Dcoth Filter Material -"_J'- ------------ ..........•..... 'D' Box ------ TYPe Filter Materiali�_ f I --` Property � Line ------- -------- E Distance to nearest: Well ARS 11L -- Foun ation -_ -- r xrr_.�. ._.. "' Rock Filled Yes No ip / Z_�1-------- Number �. ---------- Water ---- �r SEEPAGE PIT � Depth _�___�-1.�"-- - Diameter Water Table Depth --�'1-�D------------------------------------Rock-Size -- ----Y-- ,,D �� Foundation p. ! / �------ Pro Line ------ Distance to nearest: Well .-- --- Date. --------------�"------------------} REPAIR/ADDITION(Prev. Sanitation Permit# -------------- -------------------- --- I k,, ,-.m 1�11N ,..� - _ Y.. ,.k ------�-,.------------------- ------- Septic ---•--Se tic saTank (Specify Requirements) .......... - --- -------- I Field (Specify Requirements) ------ ----- --------- -- (Draw existing and required addition on reverse side) fI hereby certify that I have prepared this application, and that the work will be done in accordance with San Joaquin County Ordinancesr State Laws, and Rules and Regulirtions of the San Joaquin Local Health District. biome owner or licen- ! sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued�µl shall not employ any person in such manner as to bec e s iemct-t Work n's I ensa aws"of-Calif ornia.74. '�► T Sign -/ -- ------ ------------ } i -- - ----- ---- --- Title ------------ ------- - (If other than owner) f R DEPARTMENT USE ONLY a � - ! —� DATE 1 APPLICATION ACCEPTED BY t---- ------------------------------------------------------- -•--- DQT BUILDING PERMIT ISSUED -_ l - --------- -- -- ADDITIONAL COMMENTS __-- -"--- / " -------------- ------ --------------------- -- --------- -----°------------------------ --------- ---- ---- - -------------------------------- - -- - - ------ ------------ - --- - - ------------------------ -- --- - ---------- ---------------- -- --- - Date --��- Final Inspection by: I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.