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FOR OFFICE USE- APPLICATION OOR SANITATION PERMIT ____ _ ,-__.7 l (Complete in Triplicate) Permit No.7 Date Issued _--_----_---- This Permit Expires 1 Year From Date Issued Appl-i'cation 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 No549 and existing Rules and Regulations:. R& /I&(art�&i�a's:ta f - Q /---Wy-af- ----.-CENSUS TRACT ------------------------- JOB ADDRESS/LOCATION a E7- .Fnddq Owner's Name a�^ 6,.y dad - --- Phone ✓�`j' _., ' -Q� JC----,:L.�L7----- --------------------------------------- C'ttY ---- Gi -l---�r +lr/ti------------------------------- i - - A ac l License # --------- Phone Contractor's tor's Name -------- --------P -e-r------------------------------------- --- Installation will serve: Residence p Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ---------- Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -------------------- i. Water Supply: Public System and name- --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand A] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe-❑ Fill Material - ---------- If yes, type e (Plot plan, showing size of lot, ,Iocation 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,) t PACKAGE TREATMENT [ I SEPTIC TANK'[ ] ------------------ Liquid Depth ---!` ----------,..... . Capacity _/tea-f-------- Type pie:-( t- Material-_ Qcvc-i; No. Compartments -_ =..-- Distance 'to nearest: Well -----/.. D-_e-----------------_Founda#ion ---tQ-------------- Prop. Lin _s__-____:-_-_-- LEACHING LINE [ ] No. of Lines --------/------------ Length of each line------------- ------ Total Length ----------_--- 'D' Box .1---------- Type Filter Material A4_GJ--C---------Depth Filter Material -----_/-Q`,-----_----_- i Distance to nearest: Well -----l_-+` -�'t7_ Foundation -------- Property Property Line t SEEPAGE PIT Depth -_ Rock Filled Yes No [ � p --=------------- Diameter ---------------. Number .--------------- - ----- - ❑ � r Water To I ble Depth ----- ------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------_------------ } REPAIR/ADDITION(Prev. Sanitation Permit F# -------- ----------------------------------- Date ----------------------------------1 SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------- f---------------------------- FDisposal Field (Specify Requirements) -------- - ------------------------------------------------------------------------------------------------------- -------------- ------- ----------------------------------------------------------=------------------------ r (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 beco bj to or an'Comp nsation aws of California." r Signed - - - -- --- - - =--------------------------- Owner BY ---------- - --- ----------------- -----7------------------------------- Title ---------------- ----- --------- ---------------------------- ---------- ti€� nerM FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------ --`=-------- ---- ------------ ----------------------- ------------- DATE 1 7-2r ' BUILDING PERMIT ISSUED --------- ---- ------------------------------------------------------------ ------------------------------DATE ------------- ----------------------------- ADDITIONAL COMMENTS --------------- ---------------------- --------------------------- . �' ' -- ---------------------------- ----------�-----------� � . �" 0.. -------------------- A.0 ----------- ��= � ----------------- ------------------------------ a Final Inspection by: ---- --------Date ----�l- - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M