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FOR,QFWCE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ..................................................: Permit No, IjL.a4 <br /> (Complete in Triplicate) <br /> .......-d............... ......................... This Permit Expires I Year From Dot*issued Date Issued .. <br /> ...... ............ <br /> 41 04" �223-y2I� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and nstall the work heisin <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 97 <br /> . 15 SEDAN AVE. , MANTECA, CA. 95336 <br /> JOB ADDRESS/LOCATION ........ ..)�. ..........­11....._...-•........... .......... .......................................CENSUS TRACT .......................... <br /> Owner's Name .-C. G. ' BIANCHI & CO. 823-6423 <br /> ................................................. .................................................. ............. . . ..Phone . <br /> City Address <br /> P. 0. BOX 105 MANTECA... -------................. ......... ............__...... .......... .................... --- , CA, 9 336 <br /> N/A ................... <br /> Contractor's Nome ----------- ----------------- <br /> I--------- .................. _------.License License # .........• ......... Phone ......................... <br /> Installation will serve. Residence 0 Apartment House 0 Commercial OTraller Court 0 <br /> Motel [I Other FARM SHOP BUILDING <br /> .................................... <br /> Number of living units 9.-..__ Number of bedrooms ---9.......Garbage Grinder ...0....... LotSiz a _6 <br /> ... ...()..AC. ES <br /> R _..-................. <br /> Water Supply.. Public System and name .............I.................................. ............................... .....Private <br /> Character of soil to a depth of 3 feet. Sand L] Silt 0 Cloy 0 Peat 0 Sandy Loom-t] Cloy Loom 0 <br /> Hardpan 0 Adobe 0 Fill M6feriol ............ 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 /> NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT A) SEPTIC TANK I Size-__-1.20o...HALL.ON..... .......... Liquid Depth ...........................J <br /> Capacity l9qQ..�qATiType .................... Material--------------_---.. No. Compartments --------_-_--__ <br /> Distance. to nearest: Well -----_.304.......... ..........Foundation ....SO............. Prop. Line ..200'-_...--._.Ui <br /> LEACHING <br /> 20 0_'­­-­ <br /> LEACHING LINE, No. of Lines _---_--y------_----- Length of each line-------1,0D............- Total Length <br /> X ROCK 1 , <br /> 0' Box ............ Type filter Material .....................Depth filter Material ......?I <br /> .................................... <br /> 30030 ' <br /> Distance to nearest: well ... ................".. Foundation .................. Property Line .....200............, 1 <br /> SEEPAGE PIT Depth .................... Diameter -------__..... Number ---- ....................... Rock Filled Yes 0 No C3,4, <br /> Water Table Depth ................................................Rock Size _..----•------------------------ <br /> P <br /> Distance to nearest.. Well ........................................Foundation .................... Prop. Line ........ ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------_- Date ........................... <br /> Septic Tank (Specify Requirements) .......... . - --- ............. . .. ........7 ­------------ --....•--••.._.-----........... <br /> Disposal Field (Specify Requirements} _______ <br /> --------- <br /> -- ----- ________ ­ . .. X------ <br /> ...............I................ <br /> -------------­-­------------------------- ------------------------------------ .............. .............................................­­­..................I........................ <br /> -------------------------------------------------------------------­­.--------------- ---­---------------­...................... ................. -------------------­­................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health.01str1cf. Nome owner or lice"- <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 /> as to become subject to Workman's Compensation -laws of California." <br /> Signed --------- AN.CBI--.&.--CO. <br /> ------­---­-----------­ <br /> ...... Owner <br /> By -----P---A--RT---ER ,.. . Title <br /> ......... .......... ....... -------- <br /> of �rthan owner). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> -- -- ---- ------------------------ -- ------- -- ----------------------------.­ DATE ___7 _e-7 ----------.- <br /> I --- ------ ------------------------ *---------------- .. ............... <br /> BUILDING PERMIT ISSUED .._..-•------...._-----=-=---------------------- -------_--_--- ...............................DATE ------------_-------------- <br /> ADDITIONAL COMMENTS .._...-•-----------------------••-------•---- <br /> -----------­­_­-------- ------ ---- ---------- ----------------------- -------------------­ -------- ---------..-----._..........-----•-------•- -­---------------------•..._._....._..._.__......._ <br /> ------------------- -------------------­_­­............. <br /> ---- ----- ---- . ...... <br /> .........------•-------------• /------------------- <br /> Final Inspection by. ..... ... . .........Date ../ 3d ­n <br /> � P 6 . ............ <br /> ... . . - - 7 z/......I-------- <br /> EH 13 2h 1-68 Rev. 5m SAN JC(AQUIN LOCAL HEALTH DISTRICT <br /> 8/74 3M <br />