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-' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT' <br /> It Permit. No. ............... .... <br /> ....................I.......... ..... (Complete in Triplicate) <br /> Date Issued <br /> ......_... ... <br /> ........ ................... ..7�.�.3°:•�S <br /> .......... <br /> This Permit Expires 1 Year From Date issued <br /> _....__.----• <br /> ealth <br /> rict for a permit to construct and <br /> l the work <br /> Application is hereby made to the deSan corr►q compliance Local witlh CountytOrdinance No. 549 and existing Rules tand Regulations. <br /> re�n <br /> described. This application is ma p <br /> i ........CENSUS TRACT <br /> ' JOB ADDRESS/LOCAT{ON _ <br /> { L.E �U Phone .................................... <br /> ��R�[ H.. 1�. ...... :. .. ............:................................ <br /> Owner's !Name m <br /> City ....-: ------ P.L h <br /> Address -- <br /> P one <br /> -:.---..License # ......................... <br /> Contractor's Name ....._-- <br /> l. installation will serve: '� �TUsil ce LTJ Aportment House❑ Commercial ❑Troller Court 0 <br /> Motel []Other . ....................e`_ <br /> _... <br /> its:---- Number o€ bedrooms ._._ <br /> -___Garbage Grind 2 Lot Size <br /> of <br /> Water Supply- Public ��++ 1C - ••....:_. Private s Number pP y in units:stem and name .....C:r.U ?_�_ .- -... 7' S to ❑ .. <br /> s - " <br /> Y_ `�"`' Peat Sandy Loam Clay Loam (]'� <br /> Charactef of soil to a depth_9f 3 feet: Sand ❑. _.Silt❑ <br /> Clay Q 4 -- - , <br /> F <br /> '-,Hardpan ❑ Adabe'[] fill Material .. ....(�.. If es;typef, <br /> (Plot plan, showing size of lot, iacation'o€, system in relation to wAi,ibuildings, etc, must be ploced-on reverse side.) <br /> NEW INSTALLATION: (No septic tank or``seepage pit per i€ public sewer is available within 200 feet,) <br /> :. _ . <br /> Lid Depth <br /> PACKAGE TREATMENT ( SEPTIC TANK j j �`-cF - f __•..._...---- Liquid -•......... ..... <br /> Size.---- ----•------•..... <br /> "_. �-- <br /> Material <br /> ..-- o. Compartments ...................... <br /> IS Capacity TYp r ine ........ <br /> _ '\<jam- - :..--•--•..._ <br /> 1 Foundation Pop. L Q <br /> Distance to nearest: WelZf �. -''.....:--_.... e <br /> LEACHING LINE ,[ ] No. of Lines ---------------J` .. ength of�each line--- _ ter M nal ....................... <br /> __ Tota! Length- ----- <br /> r � � .. <br /> J, 'D' Box _--_ Type-Filfe Material ..__..... �" De th`-Fitt Pr Line <br /> ae' <br /> j-:` Foundation Property ........................ <br /> Distance to nearest: Wells_ ...... _--- t .. --...•..... No ❑ <br /> SEEPAGE PIT [ 1- Depth Diam ter ... ............ Number ....................... .. Rock Filled Yes ❑ <br /> . — -, ....... ........ <br /> _.Water Table_Depth-= <br /> r--•�l`r � '+r3�. __...---- Rock Size °.... _ <br /> Fun Lane --------------••----•- <br /> o dation_ _: op <br /> •-r Distance-to nearest:.We �� - <br /> ;: i �.. �-,..w 1...�r 4�•y- .,�,a• -- - - ---------------•-- Date � <br /> € s . <br /> REPAIR/ADDITION(Prev. Sanitation. Permit�# -...--- <br /> sr/ ... ............ __.....__....-. -_.._ .. <br /> Septic Tank (Specify'Requirer�hents) -.'..:.......... ... . ..... <br /> • _3 Imo. 13 X......... 76 •---.------ - .°. .-••._ ......74/ V7. <br /> �-IN�. ._..../S X <br /> 2 <br /> Disposal Field (Specify Requirement) _.._ _ <br /> ° . <br /> 1 - ----------------------- ............................ ...................... <br /> , . <br /> 5-- ------- ------------------•- ' <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, St t ii;aws, and Rules and Regulations of the San Joaquin Loca! Health.District. Home owner. or liten- <br /> sed aAA <br /> ' ture certifies the following: <br /> t "'I eeinthe performan a of the <br /> or for which this: Permit is issued, i !hail not employ any person in such manner <br /> as tobject to Wor 'sope cation laws of California." iSigner.-.--- ..... Owner <br /> - <br /> _ � <br /> title .................... <br /> ••................................ <br /> By ...........:............................... ... .... <br /> (If other.than owner) <br /> FOR-DEPARTMENT U1 E'ONLY <br /> _.. <br /> ` DATE ..... . ....... .... <br /> APPLICATION ACCEPTED BY ... R--•• ••.. ---..... <br /> _<w . . .,..,_ .. i` .i ` •--------------DATE ........................ <br /> BUILDING PERMIT ISSUED ....................,_.: 1 <br /> ADDITIONAL COMMENTS ............... ........... -._ _ = .. <br /> ..--- . ...... •. <br /> l _. . __ - ........:.. .. <br /> --•- <br /> • - _ <br /> . .............. ... :..... ...... . . _........._..._ <br /> r ..--•---••-_.._. <br /> ---- - -- ..... ---_-- ................................................Date _. . <br /> Final insp - - -• --•-- '•• -- <br /> SAN.JOAQUIN LOCAL HEALTH DISTRICT <br /> Y <br /> 7 J72 3 M <br /> �c. , n_.. rill <br />