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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --- ------- ------------- -- Permit No. .�.�-�b_G 7 <br /> ' (Complete in Triplicate) <br /> ------------------ ----------------- <br /> This Permit Expires 1 Year From Date Issued Date Issued ... _:..71 <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 existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _...._0a--FoT'e,t---LEA ke---Rd_,----o 'f--�5ucr�nient o--Rd---CENSUS TRACT __-_-..-_-._-._...._._. <br /> Owner's Name __ `aela...Brovelli Builder: Harold !jilliams phone 1-209-369-6268 <br /> ------------------ --- <br /> Address ..7.Q5_�er�,a S tr_e-e-t,---Galt.,---G-a1ifarnia---------------- City ----------Q_alt-------------------------------------------------------- <br /> Contractor's Name 0_al-`;Ie-3_t_er-rj---an tam : n,__ Tnc, # - 483-8473_ ______________ ___ 4_--_ ------------------------------ <br /> Installation <br /> .. <br /> Installation <br /> will serve: Residence fj]Apartment House,❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other --------------------------------------- <br /> Number of living units:----- ----- Number of bedrooms ----- .-._.Garbage Grinder ___._____-_. Lot Size ._1000 acres <br /> - - - ----------------- <br /> Water Supply: Public System and name ------------------------------------ ------•------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ 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:[ ] Size-_._-_--__.12.gQ ballon-__--__ Liquid Depth ...................... <br /> -- <br /> Capacity _15-0Q_-galrype :"'t__'_-_. y�laterial-----cemeat_- No. Compartments 2___________________ <br /> Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line -_-_---_-._-_...._-__- <br /> LEACHING LINE [ ] No. of Lines ------2________________ Length of each -tine-----100LF---------- Total Length ._2_QQL -------------- <br /> 'D' Box ----1...... Type Filter Material 3/-4_-1,/-2`4-Depth Filter Material ............................................ <br /> Distance to nearest: Well ________________________ Foundation ------------------------ Property Line -----____._.__.__-__.._. <br /> SEEPAGE PIT [ ] Depth ...2.5-1 Diameter ------3(3tk.--- Number ----------2,--------------- Rock Filled Yes [2� No i❑ <br /> Water Table Depth ------------------------------------------------Rock Size --------c.Qbb-le--------- <br /> Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line _------._._.-__.__--__ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) <br /> SepticTank (Specify Requirements) --------------------------------------- ------------------- --------------------------------------------.•---------------------------- <br /> DisposalField (Specify Requirements) ---------•----------------------------------------------------------------------------- -------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------- <br /> a (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. Home owner or licen- <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 .--- ------7- -1� --- --- Owner <br /> G�- �� n ani�ta�i.on, I--n-- <br /> Title -----------r.e�-;�det�t----------------------- <br /> s �(If t erFi o - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- - -- -- =------------------------------------ --------------------- ----- DATE ... ------------ <br /> BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------- -- --- --DATE ----- ------- ----------------------------- <br /> ADDITIONAL COMMENTS __ ________________ ________; -_ . <br /> ----------- ----- ---- ---------------- <br /> ---------------------------------------------------------- <br /> - - ------------------- - !"= = �-- "h =��------` =------ - - ------------------------------------------------------------ <br /> ----------------------------- ------------------------ <br /> • -- -------------------------------------------------------------------------------------------------------------�-------r-- - --- <br /> - -- <br /> ------- <br /> - -T---- <br /> FinalInspection bY ... � ---- ---------------- ---------------------Date -------------------------------- <br /> SAN <br /> ------ - --------------- _.__ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ` <br /> E. H. 9 1-'68 Rev. 5M <br />