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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ...V.". .'./o.)�' .....-:............ c... .... I.. ...... I ......... (Complete in Triplicate) f...... ........ ...... . t Date Issued ... ZOO This Permit Expires 1 Year From bate Issued Application is hereby made to the San Jq o uin Local Health District for a permit to construct and install the work herein described. This application is made in I" ncw}t CouAtJ( Or��. 549 and existing Rules and Regulations, 7'f JOB ADDRESS/LOCA &All ./ ..�.�. .le�c G� � ,jr' -CENSUS TRACT 5 .................... I C...........� ..•...... .....................-. . , 3..k......Ph Phone ................................. Owner's Name .... City --.....y: ---:. ......Address ..... ............................... ..License Phone.. .......Z..�r Contractor's Name ...... I Installation will serve: Residence n. Apartment House[] Commercial ❑Trailer Court• Motel (] Other ......^::............... ,............. - r Number of living -units:.:;;....... Number'of'•bedrdoms !.Garbage Grinder ........... Lot Size ........... ............... . ' Private Vt_ Water Supply: Public System and name .............................................................. ' Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Ciay ❑ Peat ❑ Sandy Loam 'Clay Loam Hardpan [] Adobe 0 Fill Material ........... If yes, type ------ .................... buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, r NEW INSTALLATION: (No septic tank or seepage pit permitted if 'public sewer is available within 200 feet,) I �C r SEPTIC TANK T ] Size ( .......... Liquid Depth .... ..1.... o. PACKAGE TREATMENT [ ] ........................ ...... Capacity.E . ' ::.. Type,;... ------ • Maferial...................... No. Compartments , ..:, :• Distance to nearest: Well ...... ...............:..... ....••Foundation ....................._ Prop. me ................ . Length of each line.............. .......... Total Length ....---••.--••••......••••-• LEACHING LINE [) No. of Lines ...... ..... g t \ 'D' Box ........... Type Filter Material ....... .........Depth Filter Material .._.....•••-...- Proper Line t Distance to nearest: Well ..... ....... ... ..--- --Foundation .... ........ ....... .. Property •-----.:............._.. i. t SEEPAGE PIT (►� Depth `5;.---. Diameter ..... Numb Number .......................... Rock Filled Yes No (] (...Rock Size . .off...`.........._ Water Table Depth ......... ............. 1 r' SO,/... t ...... ,.... Foundation ....... P........ Prop. Line ------------ ....... Distance to nearest': Well•;;..'.:. �;...-•• REPAIR/ADDITION (Prev. Sanitation Permit 4` ----•.- - Date ..... .......:....................) t t . r n� t t • .... .........� Septic Tank (Specify Requirementsh-..-,_._.�. • it i �1 ' � ' i Disposal Field (Specify Requirements) ......... ...... "-.... "'".... ....... ........... .. ....... ............. . ...-........ ....................... {Draw existing and' required 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 licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such mannar as to become subject to Workman's Compensation laws of California." Signed .. Owner` _. By ...... .......... if - e .-.an-..wner]�-� (� r- Title & ....._.... -�en' ............... ....... ........ (If other titan owner} FOR DEPARTMENT USE ONLY-- -- 7/..... _.__... APPLICATION ACCEPTED BY t~� .. ... DATE'............ BUILDING PERMIT ISSUED ........... ....... .......DAT ......................... ....... ... ...... .......... ......................:......._.•................ ADDITIONAL COMMENTS . ........ ............... ........................ ....... .... Final Inspection by:.... .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M