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OFFICE uSEi <br /> APPLICATION ICOR SANITATION PERMIT <br /> E Permit No. -:7-.7............... <br />...................................................... (Complete In Triplicate) c <br />.............••..........-.........•... ............ • -- �` II Expires Do-to Issued- <br /> Application <br /> Date Issued � y •� <br /> This Perm 1 Year From <br /> Application'is?hereby made to the San Joaquin2Locai,Health District-fora •pwmlt: to.,construd and install the work herein, <br /> described. This,application-Is made-In compliarice wit4i County Ordinance-No. 544 and existing Rules and Regulations <br /> /f 7 f f �...,...........,......CENSUS TRACT .......�... <br /> JOB ADDRESS/LOC TION ... �•!�:'-•... ..-.. ..................... .� ............ <br /> �P'!r'• Phone <br /> Owner's Nam/e� ,1f ................................. ........ ............... <br /> Address _ . .... �=`�� ter.:.. t� .......--- <br /> ' <br /> Contractor'smt/om ...... =.- ./......................�...-------•-----.....Liaense # y . .. . <br /> P one <br /> 1 <br /> Installation will serve: i R errc 'QAparttnent-Hd ;Juse� .Commercial OTratler Court Q <br /> Motel Q Other- <br /> Number of, livin units•!__-....•.. Number of bedrooms Garbage Grinder ............ Lot Size ............................................` I <br /> Water Supply: Public-Sys -------------------------- <br /> tem and name J ---=-.._ - ._ <br /> •----._...•-- ... . ._.......__-----...... ._ •--- . .....Private <br /> ' : . _- �- <br /> Character of soil to a depth of 3_feet:' Sand 0 Silt Q Clay O Peat Q Sandy Loam ❑ Clay Loam C3 <br /> Hardpan Q Adobe Q Fill Material ------------If yes,type ............... ............ <br /> 14 <br /> f <br /> IPlot 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 publlc sewer is available within 200,feet,) <br /> Size..-- � ... Liquid Depth <br /> PACKAGE TREATMENT ( ] SEPTIC TANK ......::.............•.-•---....._.__. ................................. <br /> . <br /> Capacity i ---- P <br /> __ Material.. No. Campartments - -------------...... <br /> i ..' t <br /> ....... <br /> Distance to nearest: Well --____1� --•• . Foundation .._ ............. Prop. Line --•-- S. <br /> ....... <br /> LEACHINGLINE No. of Lines `5-................ Length of each 1lneE.•---••.................... Total length .......... <br /> `D' Box _. Type Filler Material XDepth Filter Material ,c.- .............................•... .. <br /> t I 4 <br /> . Distance to nearest: Well ----.... Foundation ......................:.: Property Line ......................... <br /> 40 <br /> ` ... Diameter ...........:.:.. Number .........._........._.._.... Rock Filled Yes Q No <br /> SEEPAGE PIT: ) Depth --------------- <br /> Water Table Depth ...................•---•-•-.Rock Size --••-............_.:_........... <br /> --------------•--- <br /> I <br /> ' Distance to nearest: Well Foundation ....... Prop.-Line ..:................... <br /> REPAIRADDITION <br /> ...................................... .....----••-- <br /> J (TION(Prov. Sanitation Permit# ,... .... . s ......................... Dote .................................. <br /> 1 <br /> Septic Tank (Specify a uR qq irements) ......_.� _..... ..�`...`-: ,..�=...�.--•.. .............. ................... .........,.w. ... . <br /> Disposal Field (Specify Requirements) ......................----------------------------............................................................................... <br /> ..... <br />'E ...----•----•-- ........I.........................................................................................................._-___-.. ....... ........•.................................... <br /> ...................................................._....... .............. .....__...................................................... <br /> •i <br /> { (Draw existing and required addition on reverse aide) <br /> I hereby c iertify that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> County.Ordir;bnces,,.State, Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or itcon- <br /> Ing <br /> s the following:� ��� <br /> 11.certify tkie in—the performance of the worli-forwhich-this-permlt-Is issued, ! shalt not employ any person in such manner <br /> as to beconrelsubject to WtkmanIs ompensatien laW:of"Catifornfa. <br /> 4 <br /> Signed ............................................... Owner <br /> .. . .............................. <br /> ................................ Title ........--- .-...................... . .........................._..... <br /> .By <br /> l III other than owner) <br /> ' FOR DEPARTMENT USE ONLY <br /> I <br /> APPLICATION ACCEPTED i3Y .. <br /> ......... DATE . .. . ... <br /> E. BUILDING PERMIT ISSUED DAT): .......---....... ►....... <br /> ADDITIONAL COMMENTS ._........................................................ <br /> .........:........:.................. <br /> ........................................................................... ..... ........... ....'.. ---•..... .......... ....----......-......-•...........:.---._........ ................................... <br /> ........... . ................................. pat...... <br /> ... <br /> Final Inspection by: a .... ..: . <br /> .. <br /> EH 13 2h 1-68 Hay. 5f SAN JOAQUIN LOCAL HEALTH DISTRICT �/7� 3t''1 <br />