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FOR GFFICE u-c APPLICATION FOR SANITATION PERMIT Permit No. .7.3- •�f•••••• (Complete in Triplicate) r� Date Issued ...L'....'.... E -� This Permit Expires 1 Yec-From Date Issued l the work here;r an App'1cot:on is hereby made to the San Joaquin Local/Health u�yt0 d Horne permit d existing g Rulestand Regulations. described. This applica"ion is made in compliant CENSUS TRACT S �.�............ JOE ADD P.ESS/LOCATIODJ .� I X; .......c "/ Phone ••-" Owner's Namc CityJ�"`�/L.'��r........ .... . _. Address �t ' �tt .... License#p7/.r?�.. Phoney ' . Contractor's No rre ;i:, �j� ; Commercal ❑Trailer Court ❑ Installation will serve: ResidenceApartment House'7 �• l Motel ❑Other _ .. . ._. . .. .. ....... .... ..... Lot Size t� ...... ....... Number of livira units: Number of bedrooms •-=--Garbage Grindx.� PrivoteX Water Supply: Public System and name .. .......... ... .... ............. . .... . ..........•................................. Sandy Loam ❑ Clay Loam r f Character of soil to o Aep'h of 3 feet: Sand❑ Silt❑ Cloy ❑ Peat❑ Hardpan C] H,lohe f] Fill Material .... . .....if yes,type (Plot plan, showing size of lot, location of syst+m in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTAL:ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V PACKAGE TREATMENT ( ] SEPTIC TANK( ] Size........................... .. ......... liquid Depth .......................... ` - ..._. .. ... Material ... .... . ......... No. Compartments s Capacity . Type ..... ..Foundation op.line ................ Distance to nearest: Weil Lines length of each line . .... . ....... . ... Total Length ...................... ...... LEACHING ItNE No. of i I .Deth Filter Material .. ................ 'D' Box ..... Type Filter Material ........... ....... p y foundatioh Property line ........................ ^' Distance to nearest: '. ell .. ..... ............ .a..,................. SEEPAGE PIT [ j Depth Diameter ................ ...... Nrimber �.,.. Rock Filled Yes C3 No , • Water Table Depth �...:...........:......Ruck Size--:..-........:,...--........ Pro Line - ... Foundation .. p. ...................... • *;•:R Well ..... 1` • Distance to nearest: •-- -•-••••-•• •••••••••••••••• • ,k• ...................... ,y. Date ........... REPAIR/ADDITION(Prev. Sanitation Permit acr-y .. .... ...... .. ...... Septic Tr:nk (Specify Requirements) ..... ;- rs Disposal field (Specify Requirements) .0. / .J� ........................ .................. ........................ ............... ............ i },, ................ ........ .. ................ ................................ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the wwk will be done In accordance with San Joaquin County Orclinanccs, State Laws, and Rules and Regulations of the Sar Joaquin Local Health District.Homo owner or Ilan- 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 Parson in such manner as to raceme subject to Workman's Compensation laws of California." i Owner Signed .............. Title ....................... `. •, o her than owner FOR DEPARTMENT USE ONLY — _ _ .. ................. DATE �.'.Sv.". ................... i 's •� APPLICATION ACCEPTED BY . DATE ................................. ........ V BUILDING PERMIT ISSUED _.... ............................................................. 11 / ADDITIONAL COMMEN•iS ........................................................ ............................................................ ...... _. .. ... ... ..... . ............... .. ............................. ...... ................ ................. ................. I --P .... �. . .. ......... Date Fine! Imncot,ction:.y: �' ��S ..t ....................................................... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'G9 Rev 5M I `i