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FOR OFFICE USE: T APPLICATION FOR SANITATION PERMIT permit No. ._.v �- .......... ................. ._._I——.•--•-...---• -• (Complete in Triplicate) { ------------- Date Issued ---/0;/7/ - = This Permit Expires t Year From Date Issued ------- the work and all Application is hereby made to the San Jo''quin Local Health District for a permit and existing 9 Rulestand Regulai onsf herein described. This application is made in �p t?l��n `h'tt CouOty Or� �� 1 % �� j o 'SF `7'I p .....-.... ._ CENSUS TRACT 5�---••---•--•---•--- !08 ADDRESS/LOCATION .L- rS""` - + --yam ... ::..,: ...... .._._ % ..� - _-.• -------------Phone -------- :_._....•--..._... Owner's Name •---- -----------•-�- '�--��-'-- -------=----=-- •----- - � City ..... ---- •--.._--•----- ---•---- ---- - ---••----•-------•--• Address •---•- ----- -- ----- .License# .i!.�8-;3_ -- - --- Phone •---------- ---------•••-.-•.- Contractor's Name I Installation will serve: Residence❑Apartment House[1 Commercial oTrailer Court. Motel ❑Other.......^::.................. .......... •. - a ---- Number of living-units:.:----•-.Number-of•bedrooms _ _-.--:-Garbage Grinder' ...._{__'__ Lot Size -------------••--- __._._._,..._•- _._....Private Rr Water Supply: Public System and name ----------_-------------------------- } � � - .Clay Loam.0 Character of soil to a depth of 3 feet: Sand'❑ Silt f-] Clay [} ,Peat p Sandy Loom f�' ❑ - Hardpan C] Adobe 0 Fill Material -------._... I yes,type .__-.-_-__--._.--•-----•-•- \ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Liquid Depth ----- PACKAGE TREATMENT [.] SEPTIC TANK T ] Size------t'"=.......... p d. Maferial.....................- No. Compartments ---- ................. Ca aci' _.-. Type'i....... I Distance to nearest: Weil .__. '..--- -•-----':----- ---Foundation ---------------------- Prop. Line --,• --- : -_--- -_,...-_ Length of each line._.._.__------------------ Total Length LEACHING LINE [ J No- of Lines -- g } Type Filter Material ---.__.-' --------Depth Filter Material ------------------- 'D' Box ------------ +."" Property Line Foundation P � ------ ................ --- — Distance to nearest: Well .---.-�------- •--j�--- i -----------...- rig S Diameter ..t ------- Number ------- .............._- Rock Filled Yes (� No �❑ Depth - -.�.:-._ .. SEEPAGE PIT [ - - dr -- -�' L Water Table Depth _ Rock Size ._ So t ---------Foundation ....... .......... Prop.Prop. Line ----- Distance to neareif. Well ?.,_-:- --•••--- REPAIR/ADDITION(Prev. Sanitation Permit# -••-••- ------ ---•-------- Date + I Septic Tank (Specify Requirements).-. ._;--- --••-•_ : , - s ..-••._......._-• -••----- --••---••................. Disposal Field (Specify Requirements) ............. ----- -••--•~ _: ------------- • -, . .. ..._.. (Draw existing and required addition on reverse side) - . red this application and that the work will be done in accordance with San Joaquin. I hereby certify that I have prepae Laws, and Rules and Regulations of the San Joaquin Local Health District.Home owner or liven- County Ordinances, Stat ' sed agents signature certifies the following: erson in such mannetr "I certify that in the performance of the war k for which this permit is issued, I shall not employ any p ' as to become subject to Workman's Compensation laws of California." Owner Signed ................-_.--------------------- ---- Title -r- ti BY .................. (If other than owner} FOR .DEPARTMENT USE ONLY - rDATE --------- APPLICATION ACCEPTED BY.!. -••-..................... ......................... BUILDING PERMIT ISSUED ----------_------------ ---------------------------------------------DATE . --------- ._--•--•--•--•---.-•-••-- ADDITIONAL COMMENTS ------- ---•---- ..... .............. •....----•----------------•- - :._._.._._.. •_..._..•-_.........__._... ............................................. - y ...._.---•- ------•.................•-----...--•------- -:-•---- - ---.Dat .�-- - ------ -------- ..._. .. .-----•- Final Inspection by: .-. ---- -SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev..5M. '-