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FOR OFFICE U$EI a APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> ---------=----------------------------------- <br /> ------------ <br /> Date Issued �_(�r <br /> - ----- <br /> This Permit Expires 1 Year From Date Issued <br /> ---------------------- --------------------- <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 /> ( j <br /> J08 ADDRESS/LOCATION -. �_. 1 - ------- Q � 1 SC .LO <br /> --------CENSUS TRACT --- --_- -------------- <br /> JOB <br /> -----•---- , <br /> -- ------------ <br /> - --------A-13_x --------- T 11_ ��'`------ Phone <br /> Owner's Name - � - -•-- � <br /> `1 ------= OaDD -- _ City _FSC L� <br /> r <br /> Address --------- - - ------------ - - -, <br /> o a r . Phone 83 :_:71..Or� <br /> Contactors amen"/ ��-O� R r _SC/��G C1tniCR.License # <br /> / /�J , <br /> Installation will serve,'- --,-,, Residence}Apdrtment House�❑ Commercial ❑Trader Court ,❑ <br /> Motel E]Other _� _V----i3ftRPj__------- <br /> Number of living units:-__ oro Number of�bedrooms -----------Garba-ge Grinder -_f_V__ J_._ Lot Size _�CP�C�} <br /> t <br /> Supply: Public System and name ----_____-- ---- peat Sand Loam PrIvot 1 Q� <br /> Water <br /> - ------------------------- <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ C-4ay ter al -.-- If es,type Clay Loam i� <br /> Hardpan ❑ Adobe HFil[ rV Y Yp ------ ------------------� 99 <br /> p . 1 <br /> size of lot location of system in relation to wells, buildin~g etc. must be placed on reverse side.) \ <br /> (Piot plan, showings e Y <br /> NEWIINSTALLATION: (No septic tank or seepage pit permitted if public sewer its avaails le w,ithi0200 feet,) t <br /> SEPTIC TANK' Size__ _ '_l�_X:__J - Liquid'De <br /> -- <br /> PACKAGE TREATMENT { ] � � - -- - / <br /> �Zq0 Type I EF1Q- Material___.OaCalill_C_ No. Compartments ---- <br /> Capacity - <br /> _.�--------------- . <br /> stance to nearest: Well _______�J L�___________________Foundation -----e�------ --- Prop. Line <br /> ---------- <br /> / Length of each line------ L ------------ Total Length _---.Sf!l-----•------ <br /> LEAGHING LINE { No. of Lines --------/----------- 9 <br /> 17 ----------- <br /> ' Box _F 5 Type Filter Material g�-��---Depth Filter Material ......17 _.___ ______ .� <br /> Distance to nearest: Well --------- __D Foundation -------------149---- Property Line _�_�1�?.----.------ <br /> De th f 1_!__ -- Diameter ____ Number - --------------=-- otic Filled Yes 49 Na �] <br /> SEEPAGE PIT [ p <br /> Water Table Depth ------------- i - --------- --------Rock Size ._ <br /> Distance to nearest: Well ______ 4_- �'-_____-..Foundation ._____ Prop. Line ____ <br /> ------ <br /> REPAIR/ADDIT)ONN(Prev. Sanitation Permit# -------------------------------------------- Date ----------- - 1 <br /> : --.4.d- _ --_ <br /> Septic Ta'nk%{Speci�fy�Requ�rementsl �,�--�---`—�-----tiE�"-- - ----------------------------------------------------- <br /> -------------- ------------- ------ --- - ----- - - ----------- -- -- ----------- <br /> �+ <br /> I . : -- .... - - ----- --------------- <br /> -z <br /> Disposal Field Specify Requirem nfsl , ' :,tet 1 - -���- -- ` i <br /> --------------- <br /> -- -------------- -------- --------------------------------- - <br /> �- <br /> ---------------- <br /> existin- and re urged ad � <br /> - _---------------------- <br /> fi <br /> difion ori reverse side) <br /> I hereby certify that ).have prepared,,tthis-appilication4 tan that the work will be done in accordance witi, Sa Joaquin <br /> P.Re '1 1 3 r+t'.L <br /> County Ordinances, Stateaws, and 'Rules and''Reulations of the San Joaquin Local Heath District. HomeaRitwn or liten- <br /> 4 sed agents signature certifies the following: <br /> "I certify that inIthe performance of the work for whi�h this permit is issued, I shall not employ any person in such manner <br /> i as to b ome sub'e t t orkman's'Compensation laws of California." <br /> f --=-------------------- caner g <br /> Signed �. _ <br /> --- - - r than owner) Title <br /> i y ------- ------- -- -- <br /> (if <br /> FOR .DEPARTMENT USE ONLY <br /> i;1 ;;�� , <br /> APPLICATION ACCEPTED BY _ ---------' D---- TDYVAIS.�i��--- --------- DATE -----�� C?-'. ------ <br /> 1 .,�.�. c ------DATE --- ---- - -------=� . <br /> BUILDING PERMIT ISSUED -------------- --------- -- ----=--------- - I l <br /> ADDITIONAL COMMENTS - : Qom_ II-I� {� S7'i' M - = <br /> - ------ - -------------------- �`" --_ ---------------- --------- <br /> .- -------- _ <br /> _ -------_ - --------- <br /> 0', <br /> -------- <br /> ----------- --- <br /> --------=-- - ----- - _ Date "-_ _,------ <br /> Finallnspec' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />