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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />----------------------------------------------- <br /> --------- ; � i ri Permit �-�-�--- <br /> ;G�omplete in Tnplicatel <br /> t 0 ,,.; t. N .. <br />---------- ----------------------------------------- <br /> . .,,a., Date Issued ___`�---f�-_:-7. <br /> This Permit Expires 1 Year From'M`6Issued <br /> f <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. 540­8hd existing R,ules,and-r!,Regulations: <br /> JOB ADDRESSAOCATI N .__..� - .----S------ k= ll� CENSUS TRACT --- "--[- _---- <br /> L._• -T� <br /> Phone <br /> Owner s Name -.--__..- . � ec w <br /> Address ----�.36_'x- 5-------- -E-SC------REL0_ - • Cit c7- >�-L�f V- <br /> Y ----- ------• ---------------- <br /> Contractor's Name N- V. > -a _,V� _.a_.License # Phone - <br /> P <br /> Installation will serve: Residence j&Apartment House❑ Commercial ❑Trailer Court i❑ <br /> k Motel ❑Other ---------------------------------- <br /> ----------- <br /> Number <br /> ------------- ---------- -----Number of living units:`1 :�--:dumber of bedrooms 3------Garbag (Grinder .� Lot Size -/4 _ �•-- <br /> Water Supply: Public System and�pme --------___---_----- -- ---_ /---.---. --- Private <br /> Character of soil to a depth of 3 feet Sand'E] t❑ Clay Peat ❑ Sandy Loam ❑ Clay Loam [f� <br /> Hard an Adobe Fit <br /> p ❑ i Material __ .- >)�- tfiyes, type------- '-"------=""-=--- <br /> (Plot plan, showing size of loft, location of system in relation to wells, build'ings,­etc, must be placed on reverse side.} <br /> r--K <br /> p T seepa a pit permitted' <br /> NEW INSTALLATION: {No septic tank or °if public sewer is available within 200 feet,) /o <br /> PACKAGE TREATMENT [ } SEPTIC TANK Size_iX110 X 5 ---------------- Liquid Depth ---- ------------ <br /> A200___ <br /> ------ <br /> Capacity A2 c0--0.--- Type _- �_ J � Material_ T No.i Compartments __ i.___:__•- <br /> ----- <br /> •'-- �.�y' s�� �� �-- Pro �-�`.--•-- 6 <br /> Di, tance to nearest: Well ��-------- ----------Foundafiion _._ __ _ ___ p. Line _-__ <br /> : �.------.-__. Total Length ----- <br /> B <br /> 1 -- - - <br /> LEACHING LINE ( N of Lines ---- Length-of�each�line __ __----__---- Leg ----- J <br /> �c .: <br /> D' BoxG Type" Filter°,Mage �;a'1'_! - -Depth Filter Material --- -------•- <br /> / �-'~: ` ! ------------!-4_ ' �--+ to <br /> Dis#ance to nearest: Well _ trWAdati n ------ - -- Property Line ----- , <br /> - T---------/--j s <br /> SEEPAGE PIT � Depth __I ------ DiameterY_X-�i--.. Number-._- --a -w--- Rock Filled Yes 9?' No <br /> Water�Table Depth ---------------------Rock Size <br /> Dist nce to nearest: Well --------/tq(q-------------------Foundation !--�Ii ��___- Prop. Line ... _.__-___-----.-- <br /> f., <br /> [.•. - .. �- -Pr�•T -----------------------------------------"--_'- <br /> --------------------------`--------------------•------ O �I <br /> REPAIR/ADDITION{Prev. Sanitation Permit#'___--- =---•- --- - ---------------------- Date ------------;-----------------•--1 <br /> Septic Tank (Speci#y'Rer ements) ------------------ ------ : --- I <br /> Disposal Field (Specify Requirements) l ---- --------------------------------------' -------------------------------------- ---•----------- <br /> rz <br /> ------ ---------- <br /> t ---- ---- ------------------ ------------------------- <br /> -------------------: . ---------- --------- --- <br /> - - ..- <br /> {Draw existing.and required addition on reverse side) 0 <br /> f <br /> I hereby certify that I have prepared this application and that the work will be d6ne din accordance with San Joaquin t- <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local.Health District. Nome owner or ficen- <br /> sed agents signature certifies the following: [ <br /> :'I certif at in or ante of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to e s ect t 's Com ensati.on laws of California." <br /> Signe Owner r <br /> --i-nn--=-o---- Title ------------------- -- '-----E------------ ----- <br /> (If other than owner) <br /> FOR .DEPARTMENT USE ONLY } <br /> APPLICATION ACCEPTED BYtf - --------------------------------------------------------- DATE <br />` BUILDING PERMIT ISSUED -------------- ----------------- -- '------'--DATE ------------------------------------------ <br /> ADDITIONAL COMMENTS- - - - ---_- }_=---, -- :-::--_•-,.:.. == =,_ - --=--------- <br /> ----- ---- ------ <br /> Y_ --- ------ ----------------------- -- <br /> ► : A ;. <br /> - ------ <br /> , r ..�. . _ _. ---Final Inspectio i _-_------.Date -. --t�o 7 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I E. H. 9 1-'68 Rev. 5M " " <br />