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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- — 93 Permit No. _73 ------�- --------- ,Complete in Triplicate) Date Issued � { ---------=------------- f - This Permit Expires l Year From Date Issue herein Application is hereby made to the San Joaquin Local Health CounDtytrict for a Ord Hance permit a d ex st ng Rulestand hRegulations. described. This application is made in compliancei p �j / -- -------------------- --.CENSUS TRA CT S"y-7---• O ------- ':r .?' JOB ADDRESS/LOCATION .1-7----�d ---- ------ ----Phone ----- -------------------------•---- � Owner's Name -------- - - - - ---- - -------------- --•-------------------- Cit ----------------------------------------- Address ----- ------------1 7--P- • _ _ License # --------- -------------- Phone ------------------------ contractor's Name ------ --- - ------------------- Installation will serve: Residence,] Apartment House❑ Commercial:OTrailer Court '',❑ t Motel ❑Other ---------------------------------------------Garbage Grinder -.------ --- Lot Size ------ -� - ------------------------------Number of living units:-----f---- Number of bedrooms __-_------_- _ "--__-priate.�1 ------------------------------------------------------------------------------- Sandy------------- Loam - Cla Loam Water Supply: Public System and name ----------- -E]--- ---------------- v y. Character of soil to a depth of 3 feet: Sand' r [] Silt C] Clay peat❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type buildings, etc. must be placed on reverse side.) I (Plot plan, showing size of lot, location of system in relation ced ifw ulblic sewer is available within 200 feet,) NEW INSTALLATION; (No septic tank or seepage pit per p -..------- Liquid Depth --------------------- PACKAGE TREATMENT [ ] Size------------------ ---- --- }� SEPTIC TANK�[ ] __ No. Compartments Capacity - Material----------------- -------- Type ------------------- : P Y -- ----- - --- Pro Line ------------•=----•--- Distance to nearest: Well --------------------------- --------FoLkndation __-_-------------- P LEACHING LINE [ ] No. of Lines --------- Length of each line------------------ --------- Total Length -----------•----------••---- S 'D' Box -------- --- Type Filter Material --------------------Depth Filter Materia O Property Line -------------- - - --- --- -- Foundation ----------- Zr ------------ Distance to nearest: Well --"----------- ------ - _ __ Rock Filled Yes ❑ No iQ ` Depth Diameter umber -------------------- + SEEPAGE PIT [ 1 P —�� Water Table Depth -----------------------------------------------4 -Rock Size --"---------------------- ------ ----- -- ------- Foundation -------------------- Prop. Line ----------•------•----/ t Distance to nearest: Well "----------- ---- - u � - - REPAlRfADDITION(Prev. Sanitation Permit i# ------------------------------------ Date ___---"--"-__•_ � ------------------------- -- --- --------------------------------- Septic Tank (Specify Requirementsl ------------- 1fQ -----�- ---_ Disposal Field (Specify Requirements} ----------- - - - - --------------- -------------------- ----------------- - ---------- ---- (Draw existing and required addition on reverse s d e It will be done in ce with Son Joaquin I hereby certify that I have prepared this application and t hat the wor County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homeowner or licen- sed agents signature certifies the following: erson in such manner "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any p as to become subject to Workman's Compensation laws of California." Own er --- -- --------- ----------- Signed - Title --------------------- ------------ By (If other than owner) FOR DEPARTMENT USE ONLY ----- ----------� DATE _/D--��_--7------------------- APPLICATION ----- ------- ------ -----------DATE ------------------------------------------.. APPLICATION ACCEPTED BY - - ------------ ----------------------------------------- ---- BEJILDING PERMIT ISSUED ----- ----- ----- --- ------------------------- ADDITIONAL ----- ----- ------------ADDITIONAL COMMENTS -___-_.-__"----_----- ----------- ----------------------- - ---------------------------- ------------------------------------------------------- ---- ---- ----------------- - ---------------------------------------------- --- .....,y� �� ----- ----Dat ---- -- ----------- Final Inspection b -- -" SAN JOAQUIN LOCAL HEALTH DISTRICT u o 1-'b8 Rev. 5M _ -