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APPLICATION FOR 'SANITATION PERMIT FOR OFFICE USE: Permit No. -- --- .(Complete in Triplicate) !� 7 ----------------- V 7�p - ,Ci Date issued "_--- ----:-- --- -• -------------- ---------------------- r This Permit Expires 1 Year From Date issued - Ll ------------------;:, --- ork all the w Application is hereby made to th Son Joaquin Local Health District for a permit to construct anRuinstand Regulations described. This application is made in compliance with County Ordinance No. 549 and existing ��r CENSUS TRACT --",6--- ---•---- 2p� _� Phone ca' '�•� JOB ADDRESS/LOCATION .------ Owner's Name /+� f3 � 14' /-_liq------------------------�--`, 6� -- ----- - -------------•- City --.---f-�--- ----- --------------------------- 4s� Address � ��--�-----5------- X r11Phone ~1 - ----------=-------License # Contractor's Name -."-Q-I`� `�` ""� Residence ❑Apartment House Commercial ❑Trailer Court Installation will serve: Motel Other L� - i i Lot Size --- ------------- -- ------- .� Garbage Grinder ___"-_---- t Number of living units:_.-".-�""-- Number of bedrooms " Private Iff Water Supply: Public System and Iname _-------------------- ------------ Peat❑ Sandy Loam ❑ Clay Loam Slit❑ Clay ❑ s Character of soil to a depth of 3 feet: Sand'{ - - � .. _ if es, --- _ .. � --•- Fill Nlatei'ia1 " " �-` Y type ------------------------- w Hardpan ❑ Adobe'❑ } 'relationbuildings, etc. must be placed on reverse side.) 47�+ (Plot plan, showing size of lot, location of system i+t ed°f public sewer is available within 200 feet,] d NEW INSTALLATION: (No septic tank or seep P P -- ! Z-j------ Liquid Depth -- - r Size:------------s `_.;.._.?� - PACKAGE TREATMENT ,[ ] SEPTIC TANK'[ .,,,,ttNo• Compartments - Q Ca city/a5_10-4y ------ Type -T-11-1 - r . P ---•- -----Foundation ----�--�- ---- -- Prop. Line ---- ----f--------- +stance to nearest: Well ----------- `-a Total Length ,�--r�--�---•---------- r ' .�. Length of each line---- Q------- ------ LEACHING LINE [ No. of Lines -------- D' Box'.------- ---- Type Falter Materia pjq--_Depth FilterMaterial _"l - I Foundation _ l '�--- Property Line. ._ r Distance to nearest: Well ""-- rs �' _ --- Rock Filled Yes ❑ No 0I Diameter ---------------- Number ---------------- , SEEPAGE ?IT [ l Depth ------- -------•--------Rock Size .--------------------------- WaterTable Depth -"----------------------------- 9 rop. Line Distance to nearest: Weil Foundation -------------------- P 1 A - Date ----------•-------- ------- ------ REPAIR/ADDITION(Prev. Sanitation Permit ----------------- ----- ---------------------------- Septic Tank (Specify Requirements) --------------------------------- ------------------ ------------------------ ------------------------------------------ Disposal Field (Specify Requirements) -------------- ----------------------- ---- ------ ---------------------------------------------------------------- --------- --------------- ---------------------- -------------------------------------------------- ----------------------- - T cle ----- --- --...,�„j„��,.(Draw existing and required-addition_on..reverse_s+ .. hereby certify that I have prepared this application and that the work will be -done in accordance with San Joaquin Ih y County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or icen- sed agents signature certifies the following: to any person in such manner "I certify that in the performance of the Cork mpensation n laws ofr which California..s permit is ssued, ( shall not emp y as to become subject to orksnan's Comp Owner ---------------------•--- Signed - -- --- Title - -- -- -- -- ---- --------------------------------- ------------ --------- - - ------ -- - - - By -----" -- -- � (1f other than ow ' FOR DEPARTMENT USE ONLY D DATE f/_r. r Z ) ------ -- DATE BUILDING PERMIT ISSUED APPLICATION ACCEPTED ADDITIONAL COMMENTS ' --- - ---------------------- - ----- ------------------------------------ ----- ---- -- --------- ---------------------- ---------- ----------------------------------------------------------------------- - ------------------- - --- -------------------------- ------------------------ — -------------------------------------- -------- - - --- --- - -------------------------------------- - - -- ---------------- ---- - - Date - ---------- ---- ------------------ -- Final lnspectio SAN JOAQUIN LOCAL HEALTH DISTRICT o i_'AA Rev. 5M