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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .'l.y'�`5�3 --------- (Complete in Triplicate) Date Issued,-'-9.- ........ ssued/.9: �Z .............. ................ This Permit Expires 1 Year From Dale Issued .................................... to construct and made to the San Joaquin Local Health District dinor 0 er'mit and existing Rules tand Regulations, l the work herefin Application is hereby compliance with County described. This application is made in comp BratfJ�l I CENSUS TRA TOB ADDRESS/LOCATION .� �` .. ........ w ....... .Phone � 1 . city ............. Owner's Nome :.._. City. ..._......... . :.__ �..:.. Phone Address .License ............... u�, .. Contractor's Name - �`='�1' Trailer Court 0 I Resident Apartment House❑ Commercial ❑ installation will serve: j I Motel ❑ Other ------ .,__Garbage Grinder _.._---.---- Lot Size _q. U.�..............: Number of living units------------- Number of bedrooms - _ • _Private ❑ Water Supply: Public System and name ............:. p plySilt Clay Peat Cj Sandy Loam Clay Loam l ❑ _ Character of soil to a depth of 3 feet: Sand❑ C)-•-------------------------- Hardpan ❑ Adobe ill Material ------------ if yes,typeV to wells, buildings, etc. must, be placed on reverse .side.] a1Plot plan; showing size of loft, lOcatiarl of, system in r e�m tted if public sewer is available within 200 feet,) r ' NEW INSTALLATION: - (No septic tank or seepage p+t p Depth ....... .......•. SEPTIC TANK 3 Size------ -------------------•............_..._.... . Liquid Dep ••••--•'� PACKAGE TREATMENT ( ] Material.. _.--.• No. Compartments ..... Capacity .............. . Type ............... �. Prop. Line .. Distance to nearest: Well .................................... ...---------••----•-- 9 ...................... - LEACHING LINE j No. of Lines -'_-•---`--•----••---•-- Length of each line---.---.----•---.•r.:.._-.._ Total len th ,D Box Type Filter.Material ..._:.-.............Depth Filter Matetiti , 4 _ Foundation _...-- Property Line t Distance to nearest: Well -••- Number ...................... .... Rock Filled" Yes ❑ No { Depth Diameter ......... + SEEPAGE PIT [ ] p ...__.....Rork Size ..._ . Water Table Depth --_•------------------ p. Line - Foundation ............:....... Pro Distance to nearest: Well ........•------•--- nitation Permit�# ----- ._. Date ...........................•---... REPAIR/ADDITION(Prev. Sa I Septic Tank (specify Requirements) ......_... (Specify Requirements) •--��.-•---•�-'�'.�.N.ts----•.. ...-- - ----•---•-----•-•------'--------•-•--•. Disposal Field (Sp Y . --•-_.................. -----------------(D-------------raw existing and required addition on reverse side) - { I hereby certify that 1 have prepared this application and that the work will be done in accordance with San. Joaquin f County Ordinances, State Laws,"and Rules and Regulations of the San Joaquin Local Health District. Home owner or tten- sed agents signature certifies the.fallowing: ermit is issued, I shall not employ any person in such manner 111 certify that in the performance of the work for which this p as to become subject to Workman`s Compensation laws of California." Owner -----••-•-._......'............... By . Signed --•---- ... . . -'--• - • -- -•• -.....- . ef ....-•-•-••-•..... Title ..-. (If other than o ) FOR DEPARTMENT USE ONLY DATE ..1.. ---.11�..;�------•-•--.....' r _ APPLICATION ACCEPTED ATE ... BUILDING PERMIT ISSUED ... . f --- ADDITIONAL COMMENTS . - �R'� -----------•.............. . -•-- ................. ............... th •--- --- --- .......... ..: . -.._ :.: - ----..........-- -•:-_. .Date I Final Inspection by: SAN JOAQUIN LOCAL .HEALTH:DISTRICT . '.. ` 7/72 3.1K t11 c -