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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 73—s 6 - ---------------- ------- ' (Complete in Triplicate) Permit No. _ ------ ------- This Permit Expires 1 Year From Date Issued g� � Date Issued .__� ---------------_----------------------------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compli with County Ordinan No. 549 and existing Rules and Regulations: n a --- ��-�-- - -- ------------.--.--CENSUS TRACT --- -----JOB ADDRESS/L(QQ_/ION Owner's Name � -- - --`- - --------- ----------- -------Phone Address --------------tom- {-- ------ - - =- ---- ---e-4---d Cit Yp Contractor's Name .____ -__---_._-_ _1. '._ ..License #/ZT, sv"�Phone ------------------------------ Installation will serve: Resident Apartment House,❑ Commercial ❑Trailer Court ;❑ t Motel F-1Other Number of living units:-_(_.__.__ Number of Pedrooms ....Garbage Grinder ------------ Lot Size ---- ____:___ WaterSupply: Public System and name ---------------------------------•------- -----------------------------•---------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type -____-_-.__-_-___________ (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 tank or seepage pit permitted if public sewer is available within 200 feet,) 6 PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-----------------------------------_------------ Liquid Depth ---------- Capacity -------------------- Type -------------------- Material--------------------- No. Compartments ...................... 6 Distance to nearest: Well ____-_____________________________Foundation ---------------------- Prop. Line ...................... 0 LEACHING LINE [ ] No. of Lines ______________ Length of each line---------------------------- Total Length ............................ �'I) 'D' Box ----------.- Type Filter Material ____________________Depth Filter Material ............................................ Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ........................ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number __________________ Rock Filled Yes '❑ No L (� Water Table Depth ------------------------------------------------Rock Size --------•----•----------•------- Distance to nearest: Well --------------__________•..............Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ___-___-_________--•__•-_•------__) 0 Septic Tank (Specify Requirements) ---*----------- - - ---------------- e ------ ------ isposal Field (Specify Require,encs) /- 1 -__-- _-- - -----__--- . ---------� ----- Y_----- s.�- rf=--- ---- - - •------- --------Z------------=------------------------ Pi -' ----�------ -------- -3-------R .5 -- --------------------------------------------------------------------------------- ( existing and required addition 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 pe once of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Wor an's Compensation laws of California." Signed ----- ` -- -- ------ --- -----------•- Owner By _------------------- ------ — ---- ------------ f Title ---- 1 A ' (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --------------------------------------------------------- DATE --- -- -----� -7------------------- BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE --------------------- --------------- ADDITIONALCOMMENTS ------------- ------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•.._.__.. ---------------------------------------- ------------------------- -- -- ---- - ----- ----- - --- -------- - - -- ---------------- Final Inspection by: -------------------------------------- ate - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M