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POR OFFICE USE: <br /> . APPLICATION FOR SANITATION PERMIT <br /> ...... ............. .............. <br /> ..........-_............_..... tComptefs fn.Trip!€catel Permit No. ................ <br /> - .................................. Thb PenitEx I _ '. _ Date Issued ..................� -72 <br /> Expires 1 Year From Daft _ <br /> Application is hereby made to the San Joaquin Local Health District fora F <br /> described. This application is made in compligncerwith County Ordinance permit <br /> andexistingRules alnd Regulations: <br /> l,the work em <br /> I 1 t4 E.Q s� <br /> .JOB ADDRESS/LOCATION S o u t h end ©f <br /> / QN .----------------•----•- ••-- 1~'"U r a-A=ve <br /> --.......... <br /> Owner'.s.Name.:. .Y...oF.._:R .P9n- - Y <br /> _ . <br /> SUS TRACT -- -~ <br /> .........:..:. -t. ........:::Phone 5 9 9 ..I iJ 8 -_...------ <br /> Address P_ 17., b.Qx...�2.Z.............. ....City <br /> Contractor's Name Self - ...........-....................----------- - <br /> _- ---- <br /> ••---••-•`•`_---•--... :..._ License# Ph -- <br /> _ _... se .........-.............. one .--•-•---��-----• -------= . . <br /> lnstollotion will serve: + Residence©Apartment-House E] Commercial[]frailer Court ] <br /> Motel OtherShop BuiidinRest <br /> r© <br /> - ©rn <br /> Number of living units:............ Number of bedrooms .:.:._.._Garbage,G€inder 40 qac r <br /> Lot Size - e a <br /> j <br /> C it of p =.a........................ <br /> Water Supply Public System and rltame ..................... <br /> y .- o n <br /> .......................a_-•• <br /> � .._.....----------•----•-----•-...:..........Private ❑ <br /> Character of soil to a depth of 3 feet: Sand� Silt 0 Clay O peat d Sandy �m 0 Clay Loam.Q <br /> Hardpan 0 Adobe n fill Materia( } ........ If yes;type......... <br /> (Plot plan, showing size of lot, location of system In relation for wells, buildings,-etc.•must be placed on reverse side.[ <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 20D feet,) i O <br /> PACKAGE TRE;4TMENT``[ I- SEPTIC TAMCS �k N. <br /> : ......:. .-•---.... <br /> ' Capacity .J-I2 0 0g1TYI <br /> .Co n c r a teffterial.._____•_•--.- -- No. Compartments <br /> -�_ - e <br /> 30 ........_--••--Distance to nearest: Well <br /> .................Foundation ......_.__ ........... Prop. line 4 D ' <br /> -----•---.... <br /> LEACHING IkNE [ j No. of Lines .:_..._.�:- - 40 '' <br /> Length of each l€ne............................ Total Length _-- - -- - - <br /> 'DBox ...-YeS. Type Filter Material ...�:2"-_..-----..Dep#h F€Iter Material 42'-'......._._. A <br /> ---....--•---........ <br /> Distance tc nearest: Well ...... .Q.. ....... -- <br /> Foundation ----------- ------..... Property Line ...30 ' . <br /> SEEPAGE PIT 7 [ ) Depth -----I-Q_'•------- Diameter ---.4'-x 8' Number ...........l.-...-----•-_-- Rock Filled Yes ®x No CL7 <br /> Water-Table•Depth .Rock Size <br /> Distance 300 ' <br /> to nearest: Well ................ .. Foundation .. Prop. Line 30 ' <br /> REPAIR/ADDITION{Prev. Sanitation. Permit .-• Date <br /> :......._.... - <br /> Septic Tank (Specify Requirements) ' <br /> Disposal Field (Specify Requirements) .............. .. <br /> -----•-- .) <br /> --- -------•----- <br /> •---- <br /> existing and required addition on reverse side) . <br /> -- -------------- ------------------------• ...... <br /> "` -- - ''` `�-� �•� -•�•IDraw <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with-San Joaquin i <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:district. Horne owner or llcen-. <br /> sed agents signature certifies the following: t <br /> "I certify that in the performance ofithe work for which this permit is Issued,1 shall not employ an ' <br /> as to become sub'ect c Workman"s C pensat€on laws of California." p r y parson €n such manner <br /> Signed -----�- •-•-- • � � - <br /> ..--- ._..._��---•-- •- Owner <br /> . , P <br /> By _.._.... ill?.-• ................ Title _ <br /> (if other than owner) <br /> FO EPARTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY ._: <br /> D . _.2: <br /> BUILDING PERMIT ISSUED _.._.... - _._...._... ATE. <br /> ADD#T10NAL COMMENTS -------------------------- <br /> -------------------------------------------------------- - _--. -•--• ---- .._.. ....----- <br /> ...----•-------. • , -----••-•-.----- <br /> �. <br /> -- 110-7-------- <br /> - ----••-----•----• ----------- --..., . _.. <br /> Final Inspection b �• k7.-- a: , <br /> EH 13 2h 1-68 Rev. /� 3�' � i <br /> I SAN. JOAQUIN LOCAL HEALTH DISTRICT. $/71i 3M � <br />