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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 5_7 ------------------ - - - ---------------- ------- -- ---- - -- 8 � (Complete in Triplicate) Permit No.U-7 ------------------------------------------------------ bate Issued - -'a-7`— --_ This Permit Expires 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: G �_��I JOB ADDRESS/LOCATION .---��_�13--------�-----�-Q�TI`�_L-�-----�--- --------- ----- ---CENSUS TRACT Owner's Name -�''f CSG' �- Phone jc - a Address ---- - ,3� -----dery -1�_147_'t��--------------------------------------- city M— n-4 i OV?----------------------------------------------- Contractor's Name ' ------ //`P-----------------------------------------License Phone Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court fl Motel ❑ Other --------------------------- ------ Number of living units:---- ----- Number of bedrooms _______Garbage Grinder ----------- Lot Size W'44? -------------------•• i Water Supply: Public System and name ______________________ -------------------------------- -------Private IR of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 'D Hardpan ❑ Adobe'❑ Fill Material ------ if yes, type ------------------------ -- r- (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 Ca acit -------- Type -/g-the ---------- aterial- -=-------- -------- No. Compartments ---------•------------ P Y ----- ------ YP � Distance to nearest: Well -- ---- -------Found tion ---------------------- Prop. Line ---------_----I-------- LEACHING LINE [ ] No. of Lines ________________________ th each line______ ---- -. Total Length ___--.____---------.--.--•- W D' Box -------- -- Type Filter D th Filter Material _____--------------•-------------•--- Distance to nearest: Well ____ __________ Foundat' n Property Line ------------------------ e --- . SEEPAGE PIT [ ] Depth -------------------- Diamet ------------ Numb r ---------------------------- Rock Filled Yes ❑ NoWater Table Depth __ _Rock Size ________________ ------------ -------------------- -- Distance to nearest: Well ----- ------------------- ---••_Foundation --------------------- Prop. Line -------.-------------- REPAIRJADDITION(Prev. Sanitation Permit�# -------- ----------------------------------- Date ----------------------------------) p Septic Tank (Specify Requirements) ----------•----- ----------_ ------------------------------ Disposal Field (Specify Requirements) ------------------------------------ ----------- --------- --------x4 - ------------- -------------------------------------------- ------------------------------------------------------------------------ -------------------------------------------------------- -------- - (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, t shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signedned - -- ---------------------------- Owner ----- Title --- ------------- ---------------------------- ------------- � (lf other than owner FOR DEPARTMENT USE ONLY �q APPLICATION ACCEPTED BY ------- � `------------------- --------------------------------------------------------- DATE -----�--/.[-.'_��---- ----- BUILDING PERMIT ISSUED ------------ -------- - DATE ;. -------------- ADDITIONAL COMMENTS ---------------------------- -------------=- ` ----- ---------------------------- -- -------------- -------- -- ------------------------ ----- ------------------=--------------------- Final lnspectio Dae SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M _