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FSR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ----- (Complete in Triplicate) Permrf No. _.7-/_ _-7�_7 ----------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued --- _" Z=-�. 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 jwith County Ordinance/No. 549 and existing Rules and Regulations: JO B ADDRESS/LOCATION _ L �---2leS -- Cl<--- S TRACT -------------------------- , "_ _/lENSU Owner's Name• -------------- -- one Address -' Phone ---------------- ---------------- ----------•- City - 7 l` ' Contractor's Name �/ /6 '� 11� � --------------`----- - --------Licen'se.#� � Phone Installation will serve: �Residene J Apartment House Commercial :M—Trailer Court ;❑ . d k Motel t] Other ` -------------------------- Number --------------------- -- , Number o 1-' i f living unrts:___ _ �_..Number of bedr"ooms, ________Garbage Grinder/j/'O.S Lot Size Water Supply: Public System and name <------i__-_-- -- __PrivateI ---=---------•------------•-------------------- -: ---------- Character of soil to a`depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam El Gay Loam ❑ 5 • ' �—Hardpari-EAdobe ---Fill Material ---------/ If yes, type ____________________________ ' (Plot plan, showing size of lot, location of� system in relation to wells, buildings, etc. must be placed on reverse side.) w NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT [ ] SEPTIC TANK{4] Size----------------=------------------•--- Liquid Depth --_----------------------- Capacity ----------- ---- --- Type -------------------- Material---------------------- No. Compartments ------ ............... Distance to nearest: Well ----------------------------- -Foundation -- Prop. Line ---------------------- LEACHING ____________:_---_-LEACHING LINE [ ] No,k,of Lines --------- g ` ------ Length of each Cine--- ---------------- -------Total Length :------•---.--------_- 'D' Box ------------ Type Filter Material -----,'---------_---Depth Filter Material ---------------------------- ----- --- W. r Distance to nearest: Well _____________________t`_ Foundation ------------------------ Property Line ________________-_._-___ SEEPAGE PIT [ } Depth ------------------- Diameter --------- Number ---------------------------- Rock Filled Yes ❑ No.i❑ ' Water Table Depth ',------------------Rock Size -------------------------------- d' " : - Distance to nearest: Well ------ -----_ ___ ______________________Foundation Prop. Line ....---------- ---- a REPAIR/ADDITION'(Prev. Sanitation Permit# _ _____________ ' _____..__.____.__ ___ Date _______-______________________--_-) Septic Tank'(Specify a'CL Requirements) ------------------- -/-/{ t .-Dispos �Feld, (Speify Requirements) r ______ep ___�_ f ---------------- - --- ---------------------------------------------------------------------------- = � .----.._..__ �_ __ -------- . - ---=---------------------------------- -------------- (Draw existing and required addition on reverse side) j , I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin 0 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. home owner or licen- sed agentsygnature certifies the following: "I certify that in the performance of thewor0for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Comp sati.on laws of California." ] '� Signed Owner • --------------- BY f --- Title ---- ------- (ff r an owner] �F ------------------- H i FOR DEPARTMENT USE ONLY APPLICATION 'ACCEPTED BY -<�------ --------- 1[ATE -d > ~� BUILDING PERfU1M 155UED1......... '------ ----------------------------------------------------------------DAT.E ..----------------------------------------- ADDITIONAL COMMEN S ---------- ----------- A., - f ----------------- ------------------- ---------------_-------------- _ '- ----- - ---- ---r-___ 7-`--------------------------------` i , . D 'Final Inspection by: - ate _...------------- - - 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'S8 Rev. 5M