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FOR OFFICE USE: . 0 . . <br /> APPLICATION FOR SANITATION PERMIT <br /> ..... :..........::.::...:::.:".:::":...,..• (eornpletein.Tripiicatel .. . _ . Permit No. .7 .:'!<<L. . <br /> ...................... <br /> .. ...... ......••• ........... This Permit Expires t Yew From Dale lssaed Date Issued .A../2::2S.Y <br /> Application is hereby oracle to the San Joaquin Lcical Health District for a peftnit to construct and install the work heroin <br /> dwr,Ibed..Yhls application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulotions: <br /> _ <br /> Elkhorn Dr. <br /> JOB ADDRESS/LOCATION ........... ._....., •..r.._.......................:...:. <br /> ...CENSUS TRACT ................... <br /> Owner's Name ...:...............Mr. Bob Turner <br /> ............................. .......:........---...... <br /> Address .... 'ocT�tori.........Phone .................................... <br /> . ... ...... ........................... ...... City .... . .--- ................._......._................................ <br /> Contractor's Name Roto- Rooter 'Sewer Ser:::. ............License# .27-15,39...... Phone <br /> Installation will serve. Residence L!Aparfntent House Q Commerdal 13Traller Court <br /> Motel Q Other__.... . ......... ..................... <br /> Number a# living units:........ Number of I,edroarrts :.. .Gauge Grinder ..yew.. lot Size <br /> Water Publics Comri�nnity well <br /> Supply: System and name . ........................ ....... <br /> ........................................private <br /> Character of soil to a depth of 3 feet: Sand b silt Q Y Clay 0 Peat ] Sandy Loam 0 Clay loam D <br /> Hardpan 0 Adobe 0, Fill Materialno <br /> .......... .if yes,type........................... <br /> ' (Plot pian, showing'size of tot, location of system in relation to wells, buildings, etc. must be placed on reverse $MO.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet)' <br /> PACKAGE TREATMENT f ] SEPTIC tANK t <br /> F $� Size..... ... .. ... .:c�.t. ......... Liquid Depth . r .. .� <br /> s capacity .. 200........ Type Areca t Mdte+'1a1.......... <br /> ._.. .�4T1.o.r'eNo. Com 2..................0 <br /> _� partments .2. <br /> Distance.to nearest: Well n/a / .................foundcitiori 101............Prop. tine_5... , <br /> - �7o f V' <br /> r LEACHING LINT~ No. of Lines Length of each litie._._.:g�.r...g1_.... Total Length <br /> txl 6 <br /> 'D' Box Type Filter Material .r:,zLGk.........Depth Fitter Material:...1.8A.................. .... <br /> Distance to nearest: Well ......n/6. .... Foundation 10.f.-- - . Property Lime .51.. .rn <br /> SEEPAGE T j Depth 2ANW. Dim eter�l b3t... ..... Number�._-.___ Ay Filled Yes Na [ " <br /> f Water Table Depth -•---....: 3� Rock SI:s ,J 2 .b 11 <br /> r <br /> Distance to nearest: Well ...nf a.... :................................... .... .Foundation. l0�.......... . 'Prep. Line ......... --- <br /> IIi PAIR/ADDITION IFrev. Sanitation Permit# ............. ........................ .Date .......:..:............... ....... 7.:. <br /> t .. Septic Tank (Specify Requirements) _....----- - --_-. .. .....---- ..:._:..: -- <br /> .. ,. <br /> ......... ........_..,.........._............... <br /> Qtssa <br /> pa l .Field (Specify Requirements) ------ --- ................. <br /> ............................................. ............... ....w........................ <br /> : ------------------------------------•-- -•--------------- --- - <br /> ...................•---...........................-----:.. <br /> ..... <br /> (Draw existing and required addition on reverse side) _ <br /> 1 hereby certify that I have prepared this application and-that the work-will be done in-accordance. with Sart Joaquin <br /> Cpunty Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health,District. Homo owner or licm <br /> sed agents signature certifies the fallowing: <br /> "I certify .chat in the performance of the work for which this permit Is issued, l shall not employ any person in such manner <br /> as to become ubject to Woric an's compensation laws of California." <br /> Signed ----.----- blit <br /> .............................. Owner <br /> Owner <br /> BY - - -- ---- •--------- Title offer <br /> (If other than owner) _-- .......... <br /> FOR DEPARTMENT .USE ONLY <br /> APPLICATION ACCEPTS© BY _._._-_..-._._., . .-.:_._..DATE <br /> ....,..._?..�7. .�.rS..:......:...: <br /> BUILDING PI RMIT ISSUED _... --.._.. _ ----------•..................... .....DATE ....................... . . <br /> ADDITIONAL COMMENTS --------------- -----------------•- • ,-•-- --- _ <br /> ---------- ------- ----------------------------­ <br /> ---------------- <br /> -------------•- <br /> ------------- ..._..------ --------------------------- <br /> ---- ------ -------------------------- <br /> ------ ---- <br /> ._..------ --- <br /> 4 <br /> • <br /> a'11" , — rP� <br /> ... ._.._....Date �a <br /> Fina! Inspection by. <br /> '--"- <br /> ER 13 2L 1-68 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />