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F(. .0 FILE USEI <br /> APPLICATION FOR SANITATION PERMIT <br /> ;Complete in Triplicate) Permit No. .__... y <br /> ..................... --•----•---- <br /> -------•----------------------_. ...: .. :........._... This_Pormit Expires 1 Year From Date issued Date issued <br /> _ <br /> Application is hereby made to the San Joaquin Local Health Distrtctrfoe a~per mit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 349 and existing Rules and Regulations: <br /> JOB -ADDRESS/LOCATION _.. . . `...__'_2 82, Carp enter.•&d, �---- ---�-CENSUS TRACT ..__.._�,................ <br /> Owner's Name 111i...... Phone <br /> Address --- S'aTm..---- - city /StkM,_........................ <br /> Contractor shame31aa.ita A.!_s---Septi-0...`�`�Yek-----...........-......--Licenser# ---26$95D------ Phone ....46_3t7.Q1l.8...... <br /> Installation will serve: Residence❑Apartment House E] Commercial E]Traller Court 0 <br /> I Motel F-11Other •---------- ------ ....... <br /> Number of living units-._$x_._1 Number of bedrooms ....Garbage Grinder ^._.....__ Lot Size A.c,,, a.__....._--. <br /> Water Supply: Public System and name a' ._---------------- ------_ ....--..-----.•--_--......... .........-...Private �. <br /> Character of soil to a depth of 3 feet: SEi d�-]� Silt c Gray 0J Peat❑ Sgndy. Loam 0 ' Cloy Loam El <br /> Hardpan [] a Adobe If€] Fill AAciterial ............ If yes,type .-"-"............._..-_---- <br /> (Prot,plan, showing size of lot, loaaiion of system in relation to wells;; buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic ionk or seepoget•pit-perm eed'if-public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT .[ ] SEPTIC TAI�K.� Size= :-.......--------------------------------- Liquid Depth ----_--------- <br /> t, <br /> Capacity . __ .......... Type . ........... ---- ---,- No.. Compartments ....... <br /> Distance to nearest: Well .................. ................Foundation-•.. ...........----- Prop. Line.....__...... ....... <br /> LEACHING LINE Pq No. of Lines 2-----------___------- Length of each line........90.1........ Total Length ....9 .'_..__...__—qr <br /> 'D' Box1.......-_._ Type Filter Material ._.._. .........Depth Filter Material :`__...__._.1. " <br /> .......... Property Line .._g�.... <br /> SEEPAGE PIT [ ] f Depth ... Diameter Number _ Rock Filled Yes a• J No <br /> F Water Table Depth _1:1 ....__._ Rock Size ' ....................... � <br /> Well -----•--- `_.......w..............Foundation a _,_..,......... Prop Line ............... <br /> Distance to nearest: <br /> f <br /> REPAIR/ADDITION(Prev. Sanitation Permit F# .,-----___---_`"tt....._ __;'__. Date <br /> Septic Tank (Specify Requirements) ` <br /> Disposal Field (Specify Requirements) g©' Leash Lane. 1 <br /> t ......................- _ r --•-- ..._...._ _. �- --- ---------- .v.-------------- <br /> ............._................. ................ <br /> ell <br /> - �- .-•- ......._.._. ...,. .------------ -----•------------------_..-•--....--•-• •...--.........._.... .._ .. .. .... <br /> (Draw existing and required addition on reverse side) . <br /> I hereby certify that I have prepared thea appifedtion autii-thafillie work will lie-cone in accordance with Sart 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 fallowing: <br /> "I certify that in the performance of tho work for which this permit is.issued, I shall not employ any person in such manor <br /> as to become subject-to Workman's Compensation laws of California." i <br /> -' Signed _ • ---- ............................ Owner <br /> By..;". .L.! 1:: c' -Title _.. COYl1;T'aCt--L' ------ ------- <br /> _ ...._..__ ......_ - -... <br /> w i (if other than-owner) ; <br /> ^ I ri' FOR DEPARTMENT YSE ONLY <br /> APPLICATION ACCEP,7ED BY" .DATE <br /> BUILQING.,PERMI7.ISSUED ---....... <br /> ° -• -;4QATE ___....... ........ I <br /> - <br /> ADDITIONAL COMMENTS ... ...................... <br /> -- -------- ...._.......---•-- ............ - ------------......--. ! <br /> _ .................. <br /> ------------------------ -- -•--•- -•••----•---- -------------------"- ------------..............-------------- -----•--------- <br /> ........................... •-•-- . - •. .............. ...................... .................................. <br /> _..._......_ - -- -----. --- <br /> Final Inspection.by, - ----­---------------.......................Date:_... ��•-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT < i <br /> E.H. 9 1-'68 Rev. SM ! <br />