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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br />"......:.... ................................... Permit No, .74/47" <br /> (Complete in Triplicate) <br /> ...................4i/.'_ <br /> .. <br /> j 46 <br /> This Permit Expires l Year From Date Issued Date Issued ...9~3�..7 <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations. <br /> 2900 N Beecher Rd <br /> JOB ADDRESS/LOCATION ,...--------- ----- -- ---- ------- - '_.....:...:...:............ CENSUS TRACT ................... ...... <br /> i Sta fford m_ ..._:_.� , : .. <br /> Owner's Name .......................................................................... <br /> -••--••---- •----- ........................ <br /> ---•- Phone 786$6 .............. <br /> Address .................ftMe.......................... `+., .............................I................ City ................................................... <br /> 4 Contractor's Name ...........................s Sept jq Tank Serf;C�...... ..........License # 1. .. .$8 <br /> .............................. 77. 3•--..... Phone 4.64=527.6......... <br /> Installation will serve: Residence S ATIP <br /> artment House C] Commercial ❑Trailer Court 0 <br /> p V <br /> Motel ❑Other ....................:....g.._.._._......... 13(s. .5.. ....�, " <br /> Number of livingunits:.-_1+'....... Number of bedrooms 2.......•.Garba a Grinder Lot Size ... a...CraB................ <br /> 4 Water Supply: Public System and name --------------------------- ---•-•------------....------............. •-•-•-•-- .............................Private [ Q <br /> Character of soil to a depth of 3 feet; Sand E] Silt❑ Clay C] Peat,❑ Sandy Loam C] Clay Loam ❑ <br /> F, _ <br /> Hardpan ❑ Adobe fX Fill Material ............ If yes,type ........................ <br />' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ) Size......}X5 r X54!!................... Liquid Depth .... ,!!.............:.. <br /> Capacity 1.200.......... Type -preeaZt.. Material.Conariete No. Compartments ..2............... . <br /> ' Distance to nearest: Well 'I,00 t ..... ..Founddti101 <br /> ...... ....... Prop. U45.! <br /> .................+. <br /> LEACHING LINE No. of Lines ---- ................... Length of each line..--1I.0.0 t-.--..I......_ Total Length 1110A................ <br /> q 'D' Box ....AP.- Type Filter Material .rOCk.....:. Depth Filter Material ........2.1................. <br /> ' <br /> Distance to nearest100 Foundation ...._...._.. j. �.._. Property Line .. .t................. <br /> : Well ............... ....... p rty <br /> SEEPAGE PIT [$ Depth ....2.51......... Diameter ...36."..... Number .:....... )................. Rock Filled Yes ® No !Q <br /> s. <br /> Water Table Depth ......30fl!................................Rock Size _.I:*X7:.............--••--- ' <br /> ( Distance.to nearest: Well ......1.00 ........................Foundation... ............ Prop_. Line <br /> , <br /> REPAIR/ADDITION(Prev. Sanitation Permit#�. L.._,...r.w.'.-..�;•.:::-��-^-�-�-----,. Date - .................,...:........... <br /> Septic Tank (Specify Requiremehts) ................................ ....................�. ` <br /> .----................... ........... ------• -.... . . ....... ..... -- ------•-- <br /> DisposalField (Specify Requirements) .......................,..........,.:..................1.............................................................................. <br /> .........................--------------------------------------- -----------..........__ :.............................._ ... ., _......._...-----•--.......--••--•--•-----•---------•-----•-•-••--- <br /> ........................................................................................................._...........--..................------............_......................,.---.._.....-- .. <br /> (Draw existing and required addition on reverse side) <br />! <br /> V.hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State laws, and Rultes aifd"RfS—j0I tioft­ef-f i'S Joaquin Local health District. Home owner or Ilcon- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in such manner <br /> a`% to become subject to Workman's Compensation laws of California." <br /> Signed ................................................................................................. Owner <br /> B <br /> ............... ............ Title ...apntra..atpr.... ......:....................... <br /> y - ------------------------ <br /> (if : <br /> other than owner) <br /> s <br /> FOR D TENT USE CINLY- <br /> APPLICATION ACCEPTED BY DATE :....................... <br /> ..... <br /> BUILDING PERMIT ISSUED ..---•----•---- - ----- - ------ ------ ,...DATE�..::::::...:'.::.........------------... <br /> ADDITIONAL COMMENTS d: . . -=. .. <br /> r ......... ` ........................................................................ ................................................ .----••.._..-----..._I.........:. <br /> _i_ <br /> j ................................................................ .................................................•--..._._.._................_......------•-------------•-- ......... <br /> ,.. <br /> ' Final inspection byv/. ... ..- ........--•-Date/a/. �?..:Y---------------•-..... <br /> . <br /> s = . <br /> SAN JOAQUIN -LOCAL HEALTH DISTRICT - <br /> od <br /> a FH Z3 24 i.'68 Rev. 5M >''�" 7/72 3 M <br />