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APPLICATION FOR SANITATION PERMIT 7S )� <br /> l Permit No. .:........ ...... .. <br /> .�..:._..............•----.....---.........---....... (t:ompie»In Triplicate) <br /> ..............-.....................................-.-.. This PermitExpireslYearFromDa» Date Issued .��:s�73Issutd .. <br /> 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 oxistl!q Jtules and Regulations: <br /> JOB ADDRESS/L TION i LO...i tt /-�. � <br /> pp '+� c .r! - .�....�'` �aC.. ............................CE SUS TRACT ...n..... ................ <br /> Owner's Na '� N..Q44.c0 . ..:... '1�°� '. ................ ...... <br /> Phons4r� -fi�7�.. <br /> Address /. .. . v 57C14, — ................ ..................... <br /> Contractor's Name ---J) .- . . &4 spa:£(.V- vow.Ys'q.. �.................License # ........................ Phone <br /> installation will serve: Residence Apartment Housed Commercial {]Trailer Court Q <br /> Motel I]Other . -- ._..........._.---------I...... <br /> _ <br /> Number of living units:..)....... Number of bedrooms .,.41 .-.Garbage Grinder ............ Lot Size .�GCF! „ ..�......... <br /> Water Supply: Public System and name . --------- . .................._.......__ ---------....._....................._...................private <br /> Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay 0 Peat❑ Sandy Loam Q Clay Loom,Q, <br /> Hardpan 0 Adobe X 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 [ ] SEPT` Qt <br /> TANK n / iz�e. 1. -1[ r ............. Liquid Depth . .. �/........... . <br /> Capacity . ..pk'- TYPe -- Ga4- Mo No.No. Compartments .A��............. r <br /> oro l 0 <br /> Distance to nearest: Well -.7p...........................Fouoondation ..... ��......... Prop. Line ...66........ . .. .. <br /> LEACHING LINE No. of Lines �. . ---- .. . - ia.�..-......... Total Length ..../,164 ...-......... Z <br /> Length of each line--- - g <br /> 'D' Box I....... Type Filter Material .. . Depth FilterMaterial ..../p...1.1............................ <br /> Distance�troi nearest: Well .04.40-�.._'�dation .. r......... Property Line �I..........� <br /> SEEPAGE PIT ,p Depth ..2 .....- Diameter 'ppm 2.............. Rode Filled Yes No ip > <br /> Kl P �TO..•---. Number ...------ - 3� rr n <br /> Water Table Depth ........gS...............................Rock Size - .�2..7�-•- --SF..... g <br /> Distance to nearest: Well ....... ..................Foundation ....2D..._ Prop. Line ................... -,,v <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------__....................... Date .................................. <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) •-•-----•.................._..........._.I....................................----- ------.................................. <br /> - <br /> .---------- ----------------------------------------------------- .......... ..........................- ..........I... ---•-•--------......•-•-------------.........................--- <br /> - ------------------- --------------_ ----------------------------------------------------...................................... -- ......... <br /> ..--------------- ...................... <br /> lDraw existing and required addition on reverse side)} <br /> 1 hereby certify that 1 have prepared this application and that tit work will be don In accordance with fan Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,DisMd. Hone owner or Ilan <br /> ` sed agents signature certifies the following: c <br /> "I certify that in the onnance of the work for which this permit is Issued, 1 shall not employ any penton in such manner <br /> as to bec me subject ro Wor[(ma s Co�ptdpsnsation of California:” <br /> ` Signed ._ r -:.-. .. --- ---- -RX.0 .... �---- ---------Owner <br /> By - ------------ -------•--------- ------------ Title ... -.- <br /> . ............................ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. -- -------.._.---_------ ----- --- PATE .11_�.:- --- --..._: <br /> BUILDING PERMIT ISSUED .. -----. <br /> DATE .. ....... ...... ..... ...............ADDITIONAL COMMENTS �•�M�tfiAor'o�-as�'yG^.��/-k`m'1--{l=��S ... ... � -- ----^--....................... <br /> ----------------- ---------------- --------------I... -- ................ -- . . .. .. ... ----- ... ---.-.-.-..-.. -- • . ._..... ------........_....... -- <br /> L - - - - - --- -- . _ - ................... <br /> - � - - <br /> ../.. <br /> -:- - - - - - - - - .-Finaflaspectionby: -- - ---------- . m. . ........ .. . ........._.._ <br /> ia ......._........ ......Date . .. ..../.... <br /> - <br /> Ell 13 24 1-68 Rev. 59 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />