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FOR-OFFICE`USE7 C APPLICATION FOR SANITATION PERMIT /S 5j f -------- ------ ,'`,� Permit No. 7 t (Complete in Triplicate) t -------------------------------------------------------- This°4Permit Expires 1 Year From Date Issued Date Issued _______________ ----------___________--_-------- Application is hereby made to the San Joaquin'.Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: `ZL4 J 4 .r--� — :5 4 JOB ADDRESS/LOCATION .----------fid Nc �I-y--��---------------------��G --- -----:_. CENSUS'TRACT �~i-�C------- Owner's Name -�---- ------- 1�- 't� _.-.. ----- Phone --------------------- Address ------------------ otvr-- -p-------•------.I ------------------ City 1��t i9fl/p :- c -----�,--- ------------- ? Contractor's Name) cr'-r'�j__U_ 7 j f`I� t , lr t �� % cense #%Z-y /_._ ": P,hone ----------------------•----•-- jS ,r - Residence will serve: Residence ❑ Apartment House❑ Commercial railer Court ip_ Motel ❑`.Other--------------------------------------------- Number -------------------------------------- ----Number of living units------------- Number of bedrooms ------------Garbage Grinder --------- Lot Sizes%._------_----------__--- l ; ---------Private Water Supply: Public System and name ------:----`" ------ ----------- -------------------------------------- ---------------------- Character of soil to a depth of 3 feet: Sand' 3 i Silt[] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan Adobe ❑ Fill Material ------------ If yes, type ------------------------------ t ` [ (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,) f PACKAGE TREATMENT [ ] SEPTIC TANK:[ Size-------------------------------------- --------- Liquid Depth ---------------------.----. 6 I� O [ Capacity ------------------ €Type -------------------- Material-------------------- No. Compartments ------ ................ I Distance to nearest: Well -----------------------•---------- _ - - p• - - Foundation - . --_--- - -- -- Pro Line ______________________� LEACHING LINE [ ] No. of Lines -----_---- --4-l------_- .Length of each line------_---l------- ------ Total-L-ength �y Yl ,---_--_-_----_......_-_.-_-. 'D' Sox ------------ TYp F-lter Material ----..--------- ------Depth Filter Material ----------_--_---___----_-_---........-_-- k Distance Nell_,------------ FoundStlon------------ ----------- Property Line ------------------------0 SEEPAGE PIT [ j Depth - ------------------ Diameter ----------_ Number_ .----_--- ---------- RockJ Filled Yes ❑ No .❑ r � + Water table Dept ----------------- ---- Rock Size --- 7H-----------" ------- V1 i Distance.to nearest. ell ----------- -+ -- -------------------Foundatio . ---1--------_-_ Prop. Line ---------------------- i REPAIR/ADDITION(Prev. Sanitation Permit# -_-_------------' - #� ` f --'------ ----- t Ad " Septic Tank (Specify Requirements) ---- -- Drd-(�i-�--' _------------ Date ----------- _--�I6-T)------�� -------- 6 �&�............. Disposal nField (Specify Requirements)PAD ---- Fly- 1 ' ! + T —-------------- �_r . _ - - ,,:� -- --- BOX - ---ID6--`- -k,'Of---------2. °`------.4E, -----�-11� ----------------- --------------------------------- `,------------------------------------ --- ` ` --------------------------------------------------- Ili (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application andgthat the work will be done inna dance 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 "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." ;1 Signed ----------------Jer ------- - --------- ---------------- --- }'-------- Owner BY /" - --------- ---------------------------- � Title -----�-- - ---------- ---------------------------------------- (If than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----_ ---. y _ 7 ` --------------�`----------------------- - - - ----. DATE ----� - ,--•--�/- --•---------- BUILD, ----------- BUILDING PERMIT ISSUED - _ `' -------- ---_=_ -:-_DATE`. _: ADDIfibN- t7COMMENTS -------------------------------- --------------------- -------------------------- ---- ---- - s --- ------------------------ ------------------------------------- -------------- r ------------------------------- Final Inspection- . ---- 4-,4 :. ------------------Date -------- J_-__-- - --- ----- SAN JOAQUIN LOCAL ;HEALTH DISTRICT E. H. 9 1-'b$ Rev. 5M.