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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT '. '+�T �• 30 _ Permit No. = 6 ------ ...,�,�....,". ...M-_-�-._,_.,..,..., ..�_..._....�... _.. o p etein Triplicate) ;�. (C m I G 5 -7L ` �._ Date Issued ---- ----=--------- This Permit Expiies 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. 5r.c(h existing Rules and Regulations: � _...�_�-_�... CENSUS TRACT --------------- ------- JOB ADDRESS/LOCATION -- '7701-_UWaJL---SH------------------------------------------- ------- - --- tPhone g1w0�15-1--------- Owner's Name D. ---,Sari-g a.�.netti------------------------------------------------------ -------------=-•-- Address 12'701 E. Eight 'Mile ;•'City _� -,Stkn- --- - s-•--•• -- Contractor's Name B ack rd--$--Ste_�?_t10---`Tank------------------- ��==`:License # --26.$951 Phone �16�--'�0�� Installation will serve: Residence ❑Apartment House,❑oommercial :❑Trailer Court I❑ i Motel F-1 Other Labor---CaIAp---:------- - Number of living units_____________ Number of bedrooms Garbage Grinder; �'.__.--_ Lot Size -------3__AGr-e&----------'--------- Water Supply: Public System and name --------------------------------------------- -------------------------------------------------------- Private ] Character of ioiI to a depth of 3 feet: Sand'❑ Silt Clay ❑i Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe M Fill Material --------- '_ If yes,type ---------------------------- (Plotiplan, showing- size of lot, location of system in relation to wells,bui,idings, etc. must be placed on reverse side.) V .NEW,INSTALLATIOW (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) O ' PACKAGE TREATMENT-"[.] SEPTIC TANK'[ ] Sizet------------------ ----i---------------------- Liquid Depth -------------_�--------- � t Capacity ---------------------------------- Type f Material ------ No. Compartments ------------ ----_ .. Distance to nearest: Well ----------------------------------`Foundation -----------------A--- Prop. Line -------------- ------- E� E i = � v LEACHING LINE JE]/ ,No. of Lines -________ :A_---.____ Lengthlof each line---------x_40'._---Total.-Len,gth -_ Q!..............."`` € I'D' Box __ __1____ Type Filte' Material ----------2"----iDepth.filter Material -------1_9" r iDistance to nearest: Well ___.___5.0_'__%:____ Foundation- -----50-* Property Line ..t__..... � I SEEPAGE PITA IC] Depth - S------------ Diameter -1----- Number __+ l________________ Rock Filled Yes ® No 0 rWater Table Depth ------ D------;�----------- ----------.-Rock Size - 21' �! I :'Distance to nearest: Well .______� QO�_______________________Foundation p. 5. 0 9------- Pro Line ---- Q REPAIR/A1F0Trr=Prev. Sanitation Permit# ----------------1---------� -` :-.Date-------f-------------.------- 1 Ag _ ' ___________________________________ Sep?M-TL� (3pecify Requirements) ------------------------'---------- i ------------------------------------ ti . I Disposal Field (Specify Requirements) __________4 °�Leae-h-_1,-n��-&7-2-5 -------------------------------- ':Xkb$'� I , L S • __ _____________}----___--_______.______----t_ _---____________-_-_-----__________________.-__________-._______-_-------------- ».. •: f l {Draw existing and required addition on reverse side) r- "'" ^^�'�'"--_ti 1 hereby certify that I have prepared this appltiCation and that the work will be done in accordance with.San Joaquin County Ordinances,-.State-Laws,-and Rules and''Rog"Wations of the San Joaquin Laical 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------------ -- ------------------- -- ------------ ------------------- Owner BY -- -- � ----------- Title ------ ------------------- (if other than owner) 3 PARTMENT USE ONLY. ,. APPLICATION ACCEPTED BY ------ - - ----- -- -------------------------------------------------------- DATE -------6� 5---= � '--------- BUILDING PERMIT ISSUED ------- -- --- ' ------------------------------------------------------------------------DATE - -- -------------------- --------------- ADDITIONAL COMMENTS -- -- -- - ---- ------- - ----------- ��/// ----------- --------------- -•----- - -= = ----------------------------------------------------------------------------------------------------------------- - - - -- -- -- ------------- --------- 1. _ ----------------- --------------------------------------------------------------------------------------------------------- - ---------------------- "r, '----- -- --- -- --- ------- -------------------------------------------------------- -------- --- ----------------------- ----- ------ - --- Final Inspection,by: ------ - ------------------------------•----------- ---------------------------Date ------- t OAQUIN LOC.ALt:HEALTH,:-DISTRICT , -, E. H. 9 1-'68 Rev. 5M