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APPLICAVOR-17Orc"=�SANITATION PERMIT <br /> .7.--- <br /> .----...-•---.......-----......-•-------------­----- Permit No. ., < <br /> s </d <br /> ----------­- <br /> IComplete in Triplicate) r. <br /> .....:............................................... <br /> . 7� <br /> This Permit Expires 1 Year From Vote Issued. Date Issued -�� :............ y <br /> i t Applicatlon;f.�j,.� eF b'y;made-to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. Tidi;.'c1pplication'Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> n <br /> JOB AD ---....`o�,` .t4. - - .b_ _..._ ._.... -.............CENSUS TRACT ...,......_..._... <br /> �- Owner's Name .................. �3 ra S--------------•---............_......_....._............. .Phone _ s.'_Q .=-•--•- <br /> Address ......-_... .................. .�h.. ,_:.........- ......_.. City -.{-- :E.._...... <br /> contractor's Name _.-- QUI'..................................----------=-------.License # ....._... Phone - <br /> Installation will.serve: Residence gjApartment House 0 Commercial❑Trailer Court ❑. <br />` Motel ❑Other-------•--- - --------------- <br /> Number of,living-units:---- : Number of bedrooms ---.---._::.Garbage Grinder --------- Lot Size ------------- .............................. <br /> Water Su I Public System and namePrivate <br /> F � � . <br /> Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam <br /> *irdpari❑' Adobe ❑ Fill Material ............ If yes;type................ .....:....... <br /> (Plot plan, showing;size of lot, IQcbtion of system in telation to wells, buildings, etc. most be placed on reverse side.) <br /> NEW INSTALLATION: ' (No septic tank o seepage pit permitted if public sewer is available within 200 feet,) <br /> 1 <br /> PACKAGE TREATMENT . ( SEPTIC TAN ] Size------------=-----------•---•:-•.- ---- Liquid Depth __.. ................ <br /> Capacity ----------------- Type -------- ---------- Mhteriol---------------------- No. Compartments ..._. ............ <br /> Distance to nearest: ell _--..:...................... Foundation ---------- ___ Prop. Line .......•.............) ) <br /> s LEACHING LINE: [ j No. of Lines ................. ..... Length och line............................ Total Length .---------------._.-...... <br /> 'D' Box .._.:_...-_. Type Filte Material'=----...-----------Depth Filter Material ............................,.............. <br /> . <br /> Distance to nearest: Well - ' -:.---..---- Foundation -------------- ------ Property Line .. ... .............0 <br /> SEfPAG PIT l �. Depth -----. -- -- Diameter ---•:------ ... Number ----------------=----------- Rock Filled Yes ❑ No i❑N <br /> Water Table Depth .................................................Rock Size _..:..:.. -------- •---•---- <br /> I Distance to nearest: Well -=--------------------------------------Foundation .----- .._......_.. Prop. Line ......................0 <br /> _. <br /> REPAIR/ADDITION(Prov. Sanitation Permit# -------------------------------------------- Date ........__.._.-•---........._..._) . <br /> 4 F Septic Tank lSpecify Requirements) ------- A�200 j l.......:.........:.......:._................: <br /> Disposal Field (Specify Requirements) ----- ------ •-•----• <br /> = s =--. -------•-- ----------- ------ <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 San Joaquin <br /> .County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hoene owner or licon- <br /> sed agents signature certifies the following: <br /> !3.certify that 1wifie performance,of the work for which this permit Is Issued, I shall not employ any person In such manner <br /> ' as to become lec o Workman's Com ws of.California." p�o7- 5AKE <br /> • S <br /> Slghedk---- ------ ------------•--------------- Owner 3- 7-7 <br /> Y ------------------•--- -- -- ---- it.le <br /> ------------------ - <br /> { Of other-than owner) <br /> } FOR DEPART T LIS[: ONLY <br /> APPLICATION ACCi:PTED� BY - - - ---._- DATE .... S" - <br /> .BUILDING PERMIT ISSUED -------------------------------- <br /> ...... -...._. -• ------------- ---------------------- ................ <br /> L ADDITIONAL COMMENTS .-------------- ----•------------------------------------------------------•----- --------- <br /> ---- ---- ----------------- -- ---- ----------- ---• ----- ------------ <br /> -- -- -- --- - - - <br /> Finallnspection Date J ------- <br /> ER 13 2h 1-68 Rev. 5�j SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> FL <br />