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FOR OFFICE USE: `.: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT rc, --------------------------------------------- ----- Permit No.- -7 -�J---- (Complete in Triplicate) , ------ '� / Date -------------" -4 (�--...... __ ___.____..___._... This Permit Expires 1 Year From Date Issued z ceryl 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/LOCATIO _ CENSUS TRA T.._D________............._._._. Owner's Name J � ..r.C' - `-?! Address `11. - Phone. Q,Z . --------Zi ._._ _ P Contractor's NameG f --- -- :------+-----•------=---------------------- ----License -#. Phone m - F , Instal lation.will serve: _ Residence ❑ Apartment House.❑ Comrr19rcial ❑ Trailer Court ❑ ]) Motel Other-- Number of bedrooms___-Garbo e Grinder=_.:.____.Lot.Size____.---..c1Cr'C .q "" .- - "------ Number living units________ _____ g f-- ----�, Water Supply: Public System and name--------- . ' --=----------------Private P ❑ ❑ `i i 1 ay ❑ Peat_❑j Sandy Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: ' Sand g Silt❑ CI Hard an Adobe Fill�Matericflr-----------If yes, type"_--_---........................ [Plot plan, showing size of lot, location of system in relation to wells, 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,] PACKAGE TREATMENT [ ]' SEPTIC TANK ` ' ` Size-"__________________ " [ ] ----------------- -------------------Liquid Depth .------------------------- C apac�y epth .------------------------- Capac�y -------------Type-------r ---"-----If Material '__ l--No. Compo'r�tmenfii'' } '----------------- r.. .. Distarice.to nearest: 1Nell =------=-------=--- _,- =Foundatio n_,E` = -Prop. Line---- �. l i A - i-.-.--= 1 LEACHING LINE [ ] . No, of Lines- - �__:__ " Length of each line W -.Total„Length �>�� ."...".""_""_"-_ ID! BoxW - _Typ-e Filter Material, ��D pth-Filter Material=----caw i Distance to nearest: Well-.... ✓_ _Foundation . ..._-.Property Line . SEEPAGEyPIT' ..['�] Deptli _Diameter f Number{1 ._ y { Rock Filled Yes ❑ No❑ 'I Water Table Depth---------------------: " � . = Rock Size ---------- ----- 1 `t distance to nearest 1/1/e11 r �"' -----Fouridati .__..._ .Prop. Line..___. _- - i _ aF,. ,: ` REPAIR/ADDITION (Prev. Sanitation Permit# � :__-....:._.. "--::Date 1__..._.. _1".............} s Septic Tank (Specify Requirements)-( �0 --- 4 - - - ; - I � - x t Disposal Field (Specify Requirements] "------------------------------------ � - r = � i x = -- -----------=---- ------------=--------- - - ;- --- -- - -- - +�fie - ..--- 1 ' --------------------------r ------------------------------------------------------------. , -----;---------- ; (D�aw existing and re�qu�ed addi}on on reverse side] I hereby certify that I have prepared this. application(qnd that the work will i be done int accordante�with San Joaquin County Ordinances,titate Laws, and Rules 'and Regula.tionsV;of the San Joaquin Local Health ,District.,Home owner or licensed agents signature cer4rfies the following: -------------- R "I certify that in<,141e ei•formance of the work for which'this permit is}issued, I shall not employ any person in such manner as I to become!'subject' to Workman's .Compensation laws of California." - ,p� _ 0 Signed.:.. _. . . ------------ --- ------ --- ------- : � � 5 , " By- le --------------------------------- 77 ., : �T't i (If,other than owner) jr r 4� +`'�, • ; 6/1 .401Z DEPARTMENT USE ONLY - -------APPLICATION ACCEPTED - - DATE., DIVISION OF LAND NUMBER.-" :: DATE= =- - .. -------- ADDITIONAL COM`MENTS--------------------------" L ,..r•t - - - ---. ---- --- ----------------------------------------- -------------- ----------------------- ----- --------------- --------------------- -----------------•------------------ - =-------- -------------------------------.-------------'--- -------------- ----------------- -- ---=----------- .-- - ----- -- -- - ---- -----------------� - ------------- Final Inspection b "—` P Y' at EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fos sie» Rev. ��6 3M