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FUR OFFCE USE: j APPLICATION FOR SANITATION PERMIT - ----- ------------------------------------- Permit No. __ � -7 - . '• (Complete in Triplicate) 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. 5.49 and existing Rules and Regulations: . f --CENSUS TRACT ---_5--7 --- JOB ADDRESS/LOCATION . L _Q.t7 Vel- --1 D G a Name ------------l---/9-U —-- l Lh Vias--.�------------------------ Owner's ------------ - -------------------Phone --------------------------•--------- Address ------------------- 60------1/l!•----- �� ----------- City --------1 1 ----------------------------------------------- Contractor's Name ---_F7 — `-------.License # ------------------------- Phone -------------------------- Installation will serve.. [Residence Apartment House❑ Comgnercial[]Trailer Court i❑ Motel ❑Other ----------------------------------------- Number of living units:._-I-------- Number of bedrooms ___________Garbage Grinder -- --------- LotSize------------------------------------- ------- Water Supply: Public System and name ----------------------------------- -----------------------------------------'- -------- ---- f-----------_Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat E] Sandy Loam ❑ CIay�Loam Hardpan ❑ Adobe ❑ Fill Material _--- ----- If yes, ype --------:------------------ (Plat plan,' showing size of lot, location of system in relation to wells, buildings, etc-f-musi be: placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa a it permitted if.public sewer .pvilable within 200 feet,) t PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size---------- --- --- f-- -------- - Liquid,Depths`--------------------.---- Capacity -------------------- Type ------------------- Materia l_'_'�__F.......... . No. Compartments ----------------- ---- Pro tine;------- Distance to nearest: Well "________________________________Foundation _________.___- p. � f i LEACHING LINE [ ] No. of Lines -----------��---- Length of each line-----------------' -------- Total Length:/- ------------•---------- 6 _ ----- O Distan a tb nearest: Well f------ - ation --------/------------ Property t Line ------------------------ � Filter Material -.______.________.-Depth Filte Materia! I y p � ... i Found f p Line SEEPAGE PIT [ ] Depth --r__.----------- -- 'Diam 'ter ---------------- Number ------.�------ ------------ Rock Filled-Yes ❑ No i❑ Water Table Depth f-- Rock Size __ ---------------------------- I ------------ --------------Foundatio -------------� Prop. 'Llne,�'-----------_••-• •. Distance"to nearest:�Well '_ _____ . - t - REPAIR/ADDITION(Prev. Sanitation Permit 5# ----------------------- --------------- Date ---------------------------- .EPzf L' ---------- ------ -------- X) Septic Tank (Specify Requirements) ______f'__._____ -�' -- -- - --�--,--- '� Disposal Field (Specify Requirements) �_ ,p-..� ` JR�C ��-5i^ F4-%---MO- -`' '� X15T1 N -----r. --1----- ...... 1flJnl - == - RF - -= - -------------------------------- --T -- ---------------------- ---- ---------- i (Draw existing and required addition on reverse side) I hereby certify that I have pre{pared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Mules 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 beco a sub'ecttWorkman's Compensation laws of California." Signed..,. - _.._- __ ._...-:.. .. _ --Owner- i ------------------------ Title --------------- ---- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED CEPTEDBY ---------- �. - ----------------------------------------- DATE . r -- 7- ------------------ -TBUILDING T _ ------------------ -------DA --------------------- -- ----------------- F ADDITIONAL COMMENTS ------ ------- -------- -------------------------------------- -- - ---------- ---------- ------------------ - ------- ------ -- --- - --- --------------------------------------------------------------- - ---------------- ------ ------- -- - --- ------ ------------------- - ------------------ - ---- - ----- cDate o --- _._----F------ -•-- -- --- ------- ----------- - ------- ------Final Inspe tion - -- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. SM