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{ FOR OFFICE USjS APPLICATION FOR SANITATION PERMIT Permit No. --73 --- ------ _--_---- - (Complete in Triplicate) - ------------------------- �. Date Issued .__.��-`-------- `' This Permit Expires I Year From Date Issued 51`---- -- -------------------- work herein th rict for c, Application is hereby made to the San Joaquin 1�dnoe Local CounDfiytOrd Hance permit and existing Rules tand the egulations: �'- described. This application is made in comp ll --CENSUS TRACT -------------------------- k 3 ._Il r -- 1` C —--------------- d JOB ADDRESS/LOCATI N K _- .R. Phone Owner's Name �-. '- ..------------------------------------ - City ;.;. Address - - Phone ---------------------•------ - s �r �� ✓ --�� License # Contractor's Name -=- ---�'�`�- Installation will serve- Residence 2-Apartment House❑ Commercial ❑Trailer Court ,❑ Motel ❑Other ----------------------------------- ------ E1 _ -_-______ . - Garbage Grinder ------------ Lot Size ---------------------------------------- Number ----- ----- •----- ------- - '. Number of living units:___- -__- Number of bedrooms -- --------- --Private ❑ �L ------------------ ------------------------------- - Water Supply: Public System and name __ ____________ Peat❑ Sandy Loam ❑ Clay Loam ❑ Character of-soil-to-a-depth-of--3-feet:-° Sand Silt Clay ❑ Hardpan ❑ Adobe'❑ Fill Material ------------ if Yes,type ---- P (Plot plan,.-showing size ..ofjot.,,ilocation of system in relation to wells, buildings, etc. mswbe aceitin 200 d n reverse side.) - NEW INSTALLATION: (No septic tank or seepage pit permitted if-public sewer is available SEPTIC TANK'[ ] Size------- --------------- Liquid Depth r PACKAGE TREATMENT [ x r ' Ca acit l - Type ------------ Material---------------------- No. Compartments -------------- Capacity -------------P Y _ :_ - --------- -Foundation - ----- ------ ------ Prop. Line ------------- ------ Distance to nearest: Well ----------------------------------- --------- ---------------------- - �r LEACHING LINE [ ] No. of Lines__'"_ ----------- Length of each line---------=--------- ---- Total Length ---------------------------- --------------- qD' BoxFilter Material -------------------- _Depth Filter Material __ ------------------------ =------------ Type Distance to nearest- Well -__--________------_ Foundation - Property Line. ---------------•-------- t - Diameter ___ Number ---------------- Rock Filled Yes ❑ No SEEPAGE PIT [ } P„ r ---------Rock Size ----- ------ ------- ----- -• -- Water Table Depth -------------------------------------- jl Foundation - Prop. Line -•-------------•------ Distance to nearest: Well --__-___-________________ _ 1.. • ------------------------------ Date ------•--------------•------------ REPAIRJADDITION(Prev. Sanitation�Permit# ---------_ - ----------.------------------ ----- Septic Tank (Specify,Require = ; I Disposal Field (Specify Requirements) --- -- -------•---------------. �►/� . -- �_- t ry. +� -- -------------------------------------------- - --- ------ -------------- -- - - (praw existing and required addition on reverse side) ne in ance I hereby certify that l have prepared this application and nsthat the work will be of the San Joaquin Local oHealth District. Home'towner or Ih Son tenn i County Ordinances, State Laws, and Rules and Reguiat sed agents sigture certifies,the-following: signature person in such manner "I certify that in m the pe4;rance of the work for which This mit is issued, l shall not employ any as to become subjeet to Workman's Compensation laws of California."ai - Owner Signed----Y---------=-- ------------------- ----------- -- Title -- -------------- --------------- - - ------------------------ - l BY --------------------- lf other than owner) i FOR DEPARTMENT 175E ONLY ' ---. DATE ----- - 4�------------ - -- -- -------------------------------------------------- � ----------- APPLICATION ACCEPTED BY ---------- -- -- T ------------------------ - --------- -----• BUILDING PERMIT ISSUED .___-_ -- -- —«..-__;�.. �_ C� - ... - '"" ADDITIONAL COMMS TS - �---__--�-- � �«�-� t -------------------- --------------------- ----------------- --- ----------------------------------------------------------------------- --------------- =-------- - ------------------------------ - ---- __ _ Date - `------- y-- �------------------ � --------------- -------------- ------------ -------- --- -- - ------- --- Final'lnspection by: - - �- SAN JOAQUIN LOCAL HEALTH DISTRICT t F H. 9 1-'68 Rev. 5M