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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7 c _.....� .............. /��6•--•-•.------•- (Complete in Triplicate) Permit No. .. ............................ ............. Date Issued .............. 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 existiZS Rules an43egulatlons: J�li`wi CSG Lane, JOB ADDRESS/LOCATION ....1. (�S.Q, ...:�-. _-. �..,.. j'}' ,:. _./-T..........CE S TRACT .--- ... ....Phone ''tom/A� [� 'lI N`. Addressa --...... .................... City h . � Contractor's Name _.License Phone ..+ ..-; ... �. �_ T _ Installation will serve: Residence [ fApartment House-M Commercial ❑Trailer Court 0 Motel..❑Other . ......- -- -••--- % Number of living units:....,.. . Number of bedrooms ......Garbage Grinder ._.._...-:" lot Size ----� - Water Supply: Public System and name _..... _�. 4 ---..._.._._....--•,............................:.....Private X------,. ---- Character of soil to a depth of 3 feet: Sand❑ Silt❑ \Cloy ❑ 5 Peat❑ Sandy Loam Clay Loam ❑ Hardpan Adobe , Fill Material ...._.._.... If yes, type (Plot plan, showing size of lot, .location of system in. relatiorito wells, Y g , p buildin s etc: must be laced on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted'if public sewer is available within 200 feet,) RACKAGE TREATMENT f I SEPTIC TANK f J Size.__.....-•---------- ....-------_•........ _ Liquid Depth ...................... ... r Capacity ` �-�. Type _;__ Material.. '?' No. Compartments ...................... t Material, � � q Distance to nearest: Well .l. __lf_6----.-:__. - _-Foundation ...:_<..4._....._._ Prop. Line .... ............. LEACHING LINE f ] No. of Lines ! 7— .. .... 6ength of each Iine........ :Z ......... Total Length .... ............ 'D' Box per Material� � pth:F��Materi �------ Distance torestWell • -FoundatQnlProperty nef ._...._�.. ------------ SEEPAGE ----- . ---SEEPAGE PIT ( I Depth Diameter:q:_,+r'/ `% Number _ .�;-,...�--... ... Rock Filled Yes No 0 } f Water Table depth -_- ...... I 1 .. --•-•• ...__.. .......,.__. � Rock Size ..-- - Prop. line -----------=----••-�- 1 Distance to nel rest: Well ------------------- Foundation. _.--...- RIEPAIR/ADDITION(Prev. Sanitation Permit# ..___, ....... Date _--__- ._.__`a__.__.-) I s. i Septic Tank (Specify Requirements) ! --....---- .-_._ ............. ---- ..................... . •--- - .............:.. tr ` ..........., ................. Disposal Field (specify Requiremen [ ! ........ ................. ........... _... ....... -•------------ - -- ................... .._.........._......._._.__ ........ ....................-...-.._...................:_......................._.._.----....... .... (Draw existing and required addition,on reverse side} I hereby certify that I have prepared chis 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 permmit.is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation !a sw of California." Signed .:. . .. . ...... - --.--- -- M% Owner . -r ... ......... Title . .... . . ..._ .. ............... .....,. ................ _ wb;, (if other than owner) FOR DEP RA TMENT USE ONLY APPLICATION ACCEPTED BY ., Z. DATE ./0..-./( ... 'L ._...... BUILDING PERMIT ISSUED _ .. .................... .... ... ... ..............DATE ......_. .._ ADDITIONAL COMMENT _------ -------- ...............-------------,--------------•... ............. .........._....... ...............................•••.................. .................. --._..------•--•................................ --------•---------•--,._.:...y...-,-,-•.............................. -- ....--- ............ ,f -------------------- ----------- --- -- ........_ •.... _.._---- --- -- � � J Final Inspection by: ---- ---"----.. Date . _...... ( i�g,6?----•-•---- SAN JOAQUIN LOCAL HEALTH DISTRICT �. i3 24 7/723 - M 'i r- W I.-AR R.v_ 5M w. �'