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rvK vrrit-t UJC: <br /> -APPLICATION FOR SANITATION P' lff <br /> ...... . .... ............I.......-...---- " �/ // <br /> ' (Complete In Triplicate) Permit No. 7K:.-..-..-.. .. <br /> This Permit Expires I Year From Dah►Issued Date Issued IA:7- 2Y <br /> b' 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. 549 and existing Rules and Regulations: <br /> i JOB ADDRESS/LOCATION -12081--No.., JT2gi..-To e, Ra. Stocl*ton <br /> TRACT ...:... ................ <br /> Owner's Name Pe.te_Jauregu.i Lo .............................................:.............. .................... .....phone 07?2491......... <br /> Address .Same ......... <br /> _........ .. .... .... .. ... ........-...............City <br /> Contractor's Name ..G_.&--"Q..SP.pt1.q... an1g--Ser..................•----........License # �.-=7.-�1....- Phone 36.93Q33 <br /> Installation will serve: Residence fl Apartment House❑ Commercial QTrailer Court ❑ <br /> .. Motel ❑Other............................................ <br /> Number of living units:............ Number of bedrooms ............Garbo a Grinder ............ Lot Size ......................--..--...---.........4X <br /> 9 <br /> Water Supply: Public System and name ------------------------- .-. . ....--Private ❑ <br /> Character of soil to a depth of 3 feet: Sand Silt - Cla• 0 - y Loam • <br /> L7 ❑ Y ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( <br /> ` PACKAGE TREATMENT [ ] SEPTIC TANK{ j Size................................. ............ Liquid Depth .......................... <br /> Capacity .................... Type ----.................. Material.....-..................... No. Compartments <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ..---....------..--... <br /> LEACHING LINE [ ] No. of Lines - --------- ------ Length of each line..._..._......_.......... Total Length .............. <br /> V Box .......-.... Type Filter Material ....................Depth Filter Material -......--...............-.-..--.--..------.- <br /> Distance to nearest: Well Foundation _.. ....-.._-........ <br /> Property Line ........................ <br /> SEEPAGE PIT [ ( Depth ....""-............. Diameter ................ Number . _ ....................... Rock Filled Yes ❑ No Q <br /> Water Table Depth - ------------------------------------_....--.Rock Size ......................._•...... <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line .................. <br /> ... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -.-..-..........--.-.-.....-......I <br /> SepticTank (Specify Requirements) ..........__.................. --•-• -•-----•--••---•..............._-•------.-•........-...-.-......•_.-.....-_.._......--.-..--..- <br /> Disposal Field (Specify Requirements) 40-1---4"---tight-.line---to...1A--'1--."')°---Pox• then 1i0 r lea3ch <br /> litae...5_t-..tight---line--with D-x ! Well AS" dia. 25' deep <br /> ..................................... ----------------------------•----•---.. ........................ <br /> ` --""----- -----------".....---------------------------- - <br /> and r - <br /> IDrow existing squired 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. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 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 toworkman ompensahon laws of California." <br /> Signed ........... ...... - Owner <br /> By ..-------- -- -- - -- - --- G'mer- G & C Septic Tark Ser. <br /> p other than owner) <br /> --------------- --------------------------- Title . . ...._. ............... .. ... . -... ................... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..._. -.AC : .. --------------... --- - ------ ---- ----- DATE .. Q ..j.�.... ._... ...... <br /> BUILDING PERMIT ISSUED ------------ ---•-- ---------- - - -- ........ _DATE .. - ..... ---- <br /> ADDITIONAL COMMENTS ........... -..... ............... <br /> .... _._-... - _.... <br /> ------- .................------ - <br /> L .. ....................• ------ ................... - ---------- <br /> - .-..Dote .. _fJf L� <br /> ..... .. ... . <br /> LEH 13 2h 1-68 Rev, 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />