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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: 7 - ---------------------- ------------•----- -------------- -_�r;--- . (Complet�in Triplicate) ---- -------------------- --------------------------- 3.S' Date Issued _.___"."--- 7-•y __ - ""----------------- his Permit ExR.ires 1 Year From 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: / > JOB ADDRESS/LOCATION .-G�r-�- --�'---�� _,rG f�a/1- -------��`�`...------------CENSU n TRAMS_'_ _x$_3.1-..-------- -- Owner's Name Q- ''r----- f-F----.�_x 1;d n---------------------------------------------------------------------------Pho e Address _1 g_5• --7G Jra_ --------------------------------------- -- -------- City --5r�,1 ci_?--------------------------------------------•---•-- �J / e Contractor's Name ------ --�---�- ------------------------------------------------- ----- - License # --------- -------------- Phone ---------------------••------- Installation will serve: Residence E!�<partment House f-1 Commercial ❑Trailer Court ❑ Motel ❑Other ------------------------------------------ / 1 I Number of living units------ ------ Number of bedrooms _-Z------Garbage Grinder _A18_..- Lot Size ____ -- -- /'- - -Fa Water Supply: Public System and name --------------------------- ------------------------------------- ----------------Private [� Character of soil to a depth of 3 feet: Sand'[:] S;It❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam" i Hardpan ❑ AdobeFill Material ------------ If yes, type ----- Q (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION- (No septic tank or seepage pit perm• ed if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ]� SEPTIC TANK AJC! i e------------------- ------------- Liquid Depth --------------- Capacity --------------- --- Type -------------------- Material----------------------- No. Compartments ------------------_ Distance to nearest: Well ------------------------------------Foundation -- ------------------- Prop. Line ------- ------------------ •_:// LEACHING LINE No. of Lines ___/----------------- Length of each line_ __ - --. Y----- Total Length ___' 1....--_-_--- 1 D' Box .__._✓Type Filter Material -- ept F;Iter Material ----l_ --__-_._"______._.l__..-.---- !_5�- � ---------- Property Line Distance to nearest: Well ---3— foundation ___ _,____ SEEPAGE PIT K Depth ------- Diameter _33- ____ Number --------! Rock Filled Ye t No 0 X ��1�/ Water Table Depth Rock Size -------------------------------- / ( Distance to nearest: Well ---- • _Foundation ____1_,4__-----_ Prop. Line ____.�._...._...- ---- ------------------ REPAIR/ADDITION(Prev. Sanitation Permit# ___//)`�h-Q---------------------- Date ____-______________---------------) Septic Tank (Specify Requirements) ----------------------- ------------------------------------------ -- - ------� --------------- Disposal Field (Specify Requirements) _-- -�- -- -- �f " --------- ----------------'r�" --/-------- = - - ------�__L;`""` `-�_---- - ----- - ----- - ------- 42 - - --------------- -- - - (Draw exists and required addition on revep a side) Gcic / s r. 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. Horne owner or licen- sed agents signature certifies the following: a "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 BY ----------------------------------------------------------------------------------------- - ------------ Title ------ ----------------------- ----------------------------------------- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ------------ DATE �`".'7 ---. I_ = DATE BUILDING PERMIT ISSUED ------------------------------ ADDITIONAL COMMENTS ---------- - - - • r-- --------------------------- ------------------------------ ----------------- ------------------- ------ ---------------------- ---- -�-' � Final Inspection b Date --_.____ ° --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M