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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 711 11 Permit No. ---- ---- ------- -- ---------------------------------- ------------ t ---- - (Complete in Triplicate) § " p, i Date Issued 1-`111 J y This Permit 6 fires'1 Year'From De te,'Issued I ---- ---- - ----- -- ----- ------------- --- it.16 and Application is hereby,made to the�San incompliance-with-Coupoa uida—I Htyt0 dinaricr rn e-Nom549 a d ex sti g Rules tand Regulationl the work srein, described. This application is mader CENSUS TRACT ---------------- -------- JOB ADDRESS/LOC ATION = - [" P Phone Owner's Name -- ----------------------------- -------------- Address ---------------------------Add s Name se`#�-,��-�"�_� 7_ Phone f _ - Contractor ---- -•----_ - - Installation will serve: Residence [].Apartment House,[] Commercial :nTraile Court i ] € e ----'* --------------- --------- 1 Number of living uni:ts:.__. .--___- Number of bedrooms _-- E �. : Motel s Other ----------- -___ ► -----Garbage.Grinder -------s_ Lot Size -----�------------------------ g Private I Water Supply: Public System and.name ---------i------------------------------- 1 Character of soil to a depth of 3 feet: Sand'Q Silt[] Clay ❑_ peat[]_ S_a dye Loom -El Clay Loam Fill Materia ----------- if yes,-type Hardppanan F] Adobe �] lY e --=--- -------- ----•--- --- (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 flank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEP, TANK'[ ] Size--------------------------- --- ----------- Liquid Depth -----------•--------------- Capacii '_ =- Material-- '� No. Compartments ----- --••- S I y .2+ Type I Foundation -------/0-------- Prop. Line -------- Distance to nearest: Well _.___-_____ Lengfih of each line/0-X-�� Total Length -G---- ------ [ ] 'Lines C No, o Type Filter Material --------------------Depth .Filter Material ----•--- C. - D' Box �------- Distance to nearest: Wel! __- ------- Foundation --------------------- Property Line _---___----------,--•--- SEEPAGE PIT [ ] Depth �----------- ----- Diameter ---------------- Number --------------------------- Rock Filled Yes C-] No i[] Rock Size ----- Water .Table Depth ---------------------------------------- _ ------ --------- --------- � Distance to nearest: Well ----------------------------------------- Foundation -------------------- Prop. Line --------------------•- �. i Date --------------------------•------- REPAIR/ADDITION[Prev. Sanitation Permit --- - 1 p r --------------- - pplc Tan (SpecifyRequirements) ------- - ----------------- ------------------- --------------- Disosal Field (Specify Requirements) ----------------------------------------- ----- i ----------------------------------------------------------------------- - g -------- ---- i - (Draw existin and re aired addition on reverse side) 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 liven-. sed agents signature certifies the following: person in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any as to become subject to Workman's Compensation laws of California." Signed ------ ----------------------------------------------- Owner r ---- ------- - • ----- --------------------------- Byoe- ------------- ------ ------------------ Title -- (if other than own er] FOR D Alt ENT USE NLY I --------------- DA7E - l 7 APPLICATION ACCEPTED BY.-----� -- - --- -----•--- ----- ----- -------------- - -=----- DATE ---------------- --------------- BUILDING PERMIT ISSUED --- `i ------ . ADDITIONAL COMMENTS ;--------- --------------------------------- - ------ ------- ------------------- ---------------- i ----------------- ---------- I ------------------------------------------ -- -- --------------- -------- e-7 -. _ Final Inspection b � - - = ---- -- - -- --- � - gate -. �- ----�~ ------ - --inal - - SAN JC�AQU{N .LOCAL EALTH DITRICT �. ` E. H. 9 l-'b$ Rev. 5M. a