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0 <br /> FOR OFFICE USE: <br /> APPLICATIOh FOR SANITATION PERMIT <br /> ------- ----- Permit No. <br /> —(Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ._-10701-_E.--.--Copperl,opis----------- --- ----------------CENSUS TRACT -------------------------- <br /> Owner's <br /> -------------------- - -Owner's Name ........V-----CaSS_1dY----------------------------------------------------------------------------------------------Phone -- -�"6Z-n.ZI_7_0----------- v <br /> Address --------go---N,---'-2'3z-1-_q&------------------------------------------------------------------- City ---------- -tk-ri-.---------------------------------------------:-------- <br /> Cont�actor's Name ----B1ackardt s__SeptiC Tank License # 26�9j� .------- Phone 46-3--70 8------- ' <br /> Installation will serve: --Residence-K]-Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units-----_j----- Number of bedrooms __3---;----Garbage Grinder ------------ Lot Size _.__92'_--X___ 21-1-------- <br /> - <br /> Water Supply: Public System and name ---------------------------------t--------------------------= Private ® ' <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam <br /> Hardpan AdobeX% Fill Material ______________If,. es, t e ______.______.___.__________ x <br /> P ❑ � Y YP � - <br /> 0 ; <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. M sr be placed on reverse side.) V <br /> NEW INSTALLATION: (Noseptictank or seepage pit permitted if public sewer is available within 200 feet,) 0 <br /> PACKAGE TREATMENT [ ] ' SEPTIC TANKk) ;Size_____s ! Yp_*____- --_.---------- t1quid„Deptk8t!_'t___________________ <br /> Capacity _1204 Type -----5_q_' ------- Material---_-_con•;- __-- No. Compartments �. <br /> _ 2 <br /> Distance-to nearest: Well7_ -/aQ-- --____~__--___Foundation --_.11.9__-- ,� _____ . <br /> ____-- Prop. Line -_--- ---- _ <br /> LEACHING LINE No. of Lines 2-------_ Length of each line---------6G! _ Total Length ,___-.2,Di.............. <br /> 'D' Boxy------------ Type Filter Material ------at'---------Depth' Filter Material ---------- 9'_7-_.----------------------- <br /> ' Foundation �l3 �- _ -- Pro '�r <br /> i <br /> Distance to nearest: Well ----- �D peaty Line ________________________ <br /> SEEPAGE PIT b1i Depth ____25-'------- Diameter -----48 Number __2 -------------- Rock'Filled Yes [5 No I] <br /> Water Table Depth --------40-----------------------------------Rock Size -------- --------------------- <br /> � E <br /> Distance to nearest: Well __-___.____—ZO-�___,r__________Foundation _. __©_____ Prop. Line ..... ---_--_ <br /> j <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date -------------_-----•-------------_I . <br /> Septic Tank (Specify Requirements) -- ----------------12Q0---gal---------------------------- -------------------------------------------------------------- -------- <br /> Disposal Field {Specify Requirements) -------12-0-'----Lea-ch--Line4---2 ---.48"X2-5-'------pi-ts------------------------------------- <br /> —"" --------------------------------------------•--------- t <br /> --------------------------------------------------------------- ----------- -- ---- - ------------------------------------------------------------------------------------------------------------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared,this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature-certifies the following: <br /> "I certify that-in the—performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become-subject to Workman's Compensation laws of California.” <br /> Signed ----- ------------------------------------------------------------------------------------------- Owner <br /> By ....'_.Bill Bl,ackard Title --____--Contractor <br /> - --------------------------- <br /> --(If-other.-than,owner) <br /> # FOR .DEPARTMENT USE ONLY nn� <br /> APPLICATION ACCEPTED BY -------------------------------------------- DATE a~y. a------------------ <br /> ---- -- - --- ----------------------------------- <br /> BUILDING PERMIT ISSUED ------------- ------------------------------------------------------------------=--------------DATE -------------•----------------------------- <br /> ADDITIONALCOMMENTS ------------------ --------------------------------------------------------------------- ----- --------------------- --------------------------- <br /> --------- _�� `�" <br /> - - ------------------------------------------ -- -- - <br /> - --- - - - --- -- ------------------------------------------ <br /> -------------------------------------- ------------ - -------- - <br /> - - - <br /> -------------- --------------------=------------------------------------------ - -- -- -- -- - <br /> FinalInspection by: ------ ------------- -----------------------------------------------------------------------Date __`p.� ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Gam` <br /> E. H. 9 1-'68 Rev. 5M <br />