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FOR OFFICE USESp APPLICATION FOR SANITATION PERMIT -----._.-....---------1..:- " (Complete in Triplicate) Permit No. 7-7/FV . _ -_ _._ _ _ ----- .............___-____---_ This Permit Expires 1 Year From Date Issued 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: .. JOB ADDRESS/LOCATION' ------ CENSUS TRACT .-------------------- Owner's Name Gr �c�_--- lG --------- - ------ --- --------------- - Phone - Address ----la_OK__TS _.__ �E-•',L� ------ ---- - - - -------T__ City ----- - --------...-- Contractor's Name ......___- -�J-'ee—p-��+_�e,,19�i.,,�..�.License # -'ls�--;?. ?Phone _ -�..1-- ------ Installation will serve: dence<Apartment House ❑ Commercial [ Trailer Court ❑ Mot,el`�❑Other .___ Number of living units:... Number of bedrooms ..�-----Garbage Grinder ____.__ Lot Size __ Q_/q��-- Water Supply: Public System and name ..----_.Killaierial __- ----------------.-------------------------------------PrivatK Character of soil to a depth of 3 feet: Sand n Silt❑ ClaPeat❑ Sandy Loam ❑ Clay Loam E]Hardpan ❑ Adobe ❑ ...._-__ 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 f ] Size---_--------------- ---___ -----.--- Liquid Depth -- 6 Capacity ------------------- Type ----------------- Material----------------.__ No. Compartments ------------____ 0 / Distance To nearest; Well ......-----_-.__----________Foundation __-.__-_-______ Prop. line ---------_----------- 6 _ LEACHING LINE _ [ ] No. of Lines .._-! -- -....-... Length of egch Ijne---_.- ---------- Total Length --- L6 �_....-..-.-- ' / �m cI �jCIS��Y 'D' Box �c.)--- Type Filter Material _/.� '.-- -Depth Filter Material -.-,1e_- -_- Distance to nearest: Well -.... l_6-_- -- -- Foundation __ -------- -- Property Line --_�� -�-___...._ SEEPAGE PIT [ ] Depth ___ ._ Diameter --- .-__. Number .......... Rock Filled Yes 1�No 17 9' Water Table Depth e- ---------------------------- - Rock Size _ __ d rS- r Distance to nearest: Well -.------... ---.--- _---- ----------Foundation -------- ---- Prop. Line --_----___.__----.. REPAIR/ADDITION(Prev. Sanitation Permit# Date ----------------------------------) Septic Tank (Specify Requirements) ------------------- - -- - - -- --- --------------- Dispo I Field (Specify Requirements) _-.. r --- - ------------- - - ---- --- -- -- ----_._..--Dra ---xisti- 9- - q (Draw existing and re aired addition on reverse side) I hereby certify that 1 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, 1 shall not employ any person in such manner as to becom ct to o man's omp ation laws of California." Signed -- _ _ _ .- -- _ _ Gu------ -_ _-_- __ Owner By ----- --- --------------- ----- --------- a Title - (if other than owner) FOP, DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ _ ____ -------------- - -- DATE -..__ .-1- - ---Z- ---- BUILDING PERMIT ISSUED ..._ ... __-.------DATE .._..- _- ADDITIONAL COMMENTS .......... - . - -------------------------------------------- ------------- - ------------------- --- - ------------ ----------------------------------------------- ----------------------------------------- -- ----- - - -------- - -- Final Inspection by: - - ------------------------ --------------------------------------------Date -'._F.--. --- -L� ...- --- A SAN JOAQUIN LOCAL HEALTH DISTRICT v �-D