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FCR OFFICE USE: F -=� APPLICATION FOR SANITATION PERMIT ----------------' ---- ------------------------ Permit No. 7 ------------ (Complete in Triplicate) ------------------------------ -------------------------- This Permit Expires T Year From Date Issued Daae 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 mad n c 'once with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 5i+. _y__ Q.�- -u ------- a_�j---_--_S_a._- - - 44_ O' ENSUS TRACT Owner's Name _�_ - ----------- -----------7---------- -Phone Address '- ' ' t City Contractor's Name -..- .---'�------_-__\G�- ------------------------------License # g7153_�--- Phone Installation will serve: Residence ❑Apartment House o',Commercial ❑Trailer Court M Motel ❑ Other ------------ ------------------------------ 4, Number of living unit's:----- Number'of bedrooms ________Garbage Grinder _f e_`l_l Lot Size __________________ 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 ❑ Adobe Fill Material -/Uj -- 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 se•wer is available within 200 feet,) X "V PACKAGE TREATMENT j ] SEPTIC TANK:14' ize____ /_v� rte_ _ ___._______ Liquid Depth __ VZ____.___,_• /� . . /- P Capacity - __-,-- Type -- ! � MaterialNo. Compartments ---;�r=__---------- Distance to. nearest: Well -------------Foundation ____ Prop. Line ........ LEACHING LINENo, of Lines -------�------- Lengths of ach line_ _-- 4---- Total Length _ _ .......... 'D' Box _�_�,..5_ Type Filter Material -0 ___Depth Filter Ma;terial ___�If-_--_____________________________ Distance tO nearest: Well ---=7�7=--------- Foundation ------------ Property Line SEEPAGE P17 Depth �S______ Diameter p f - 3 �_ Number _------ ______ Rock Filled Yes No � . Water Table Depth --------�.�------ ------------------------Rock Size /_l?.-,�'��--=-------- - Distance to nearest: Well -----------------'___�_•___-_____Foundation _-/ C _:f_____ Prop. Line ____, ...__.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _______.______.___-_______________} SepticTank (Specify Requirements) --------------------------------------------------------- -------------------------------------- -----------•- --------------------------- Disposal Field .(Specify Requirements) ------------------------------------------------------------------------------------- ----------------------------------------------- --------------------------------------------------------------------------------------------------------- ----------------------------------------- - (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 licen- 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 --------------- ---------------------------- ---------------------------------------------------- Ow q� - GYr1<rc.�C / By ------------------------- - Titl .. (If other than owner) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE -`�� ¢�'` BUILDING PERMIT ISSUED _______ - ---------------------------- -- --- --------------------- - ---------------------- -..:...DATE --------------------------------------------- ADDITIONALCOMMENTS - -------------------------------------------------------------------------------------------------- ----------- -------------------- -------------------- ----------------------------------------------••------ ;---•---------------------------------------------------------•----------------------------------------- ---------------- --- ----------------------- --- -------- --- ------------------------- ------------- ------------------------ ---------------------------- - - --------- ----------------------- ---------- ---- -- ------ -- --- -- Final Inspection by: --------------------------Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M