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FOR OFFICE USE: s APPLICATION FOR SANITATION PERMIT _ --------------------------------- ------------- Permit No: 73 �... I (Complete in Triplicate) Application _____ ____ ____ _________ This Permit Expires ] Year From Date Issued Date Issued cation is hereby made to the Son Joaquin Local Health District for ermit to construct and install the work herein PP Y q permit described. This application is made, in compliance with unty Ordinance No. 549 and existing Rules and Regulations: /!5p JOB ADDRESS/LOCATI -- - !i _-_ _.� -------------------CENSUS TRACT ------------------------- Owner's -- - ----•-•---•-- Owner's Name -- ------------ ---•--------•-------•----------- ----- - --------Phone ---------------------•---- Address ._-�__ _ v ----- ----- - --- --- - - ----- - City _______________________________________________ k V_ Contractor's Name - --- --- - --- ---------------------- License # _ s _ _ '._ Phone Installation will serve: Residence X Apartment House Commercial :17railer Court ,❑ I Motel ❑Other __.------------------------------------------ Number of living units:---- Number of bedrooms ---T�.Garbage Grinder ------------ Lot Size --_--_----_------------------------------- I Water Supply: Public System and name . ----------------------------------- -----------------------------••--------------------------------------Private Character of soil to a depth of 3 feet! . Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam Hardpan-E] ._:Adobe-Q -Fill_Material - .-.--- If yes,_tyPe------------------------------ (Plot ----------- ---- --- ---(Plot plan, showing size of lot, location of-system in relation to welds, 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,) i PACKAGE TREATMENT [ I SEPTIC TANK f ] Size------------------------------------------ - Liquid Depth ---_-----_---__---_-----. Capacity ---I---------------- Type -------------------- Material------ --------------- No. Compartments ---------- ----------- Distance to! nearest: Well --------------- -----------------Foundation -._- ----------------- Prop. Line -_----_----_-_-_-_-__- LEACHING LINE [ j¢ . No. of Lines ------------------------ Length of each line---------------------.------ Total Length -----.---------_-- ....... k 'D' Box ----------- Type f=ilter Material --------------------Depth Filter Material --------------------_---..................... r J Distance to nearest: Well ------------------------ Foundation -----.- ---------------- Property Line. ___-_.._-__.......... SEEPAGE PIT [ ] Depth ------------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth --------------------------------------- --------Rock Size -------- ....................... Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ....__.. ......... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) r Septic Tank (Specify Requirements) -------------------------- ----------------------------------------------- -------__.----- ---------------•-----•---- Disposal Field (Specify Requirements) _-- ^ - � " ' I p ` 1. - -- - ------ - ----- -- - - ------ --------- u. . . - - , (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 liven 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 manner as to become subject to Workman's Compensation laws of California." Signed --------------------------------------------- _ Owner Y ---------------- -- ----- Title ^ B ------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' ---`---------------------------- ------------- ----------------------- ---------- DATE --- ------ ---------- BUILDING PERMIT ISSUED -------------------------- ---------------------- -------DATE ------------------------------------------- ADDITIONALCOMMENTS -----------------------------------------------------I---------—------ ------ --------------------------------------------------------------------------------- I ----------- --------------- ------------------------------- -------- -- ----------------------------------------------- --------------------- ----------------------------------- ------------ ----- ---------- ------------------------------------------------- -------- ---- ------------------------------------- ---------------------------- ---------------------------------------------------------- ------------ - Fina! Inspection by: -- �= f ----------------------------------------------------------Date ��. ------- Final i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �`. i