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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. C� <br /> . 3- f�. <br /> - <br /> (Complete in Triplicate) <br /> V <br /> _.. _.._- ........ <br /> Date Issued <br /> --. <br /> �- - __- ----- ------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereir. <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ,- . 11211 'To, whine CENSUS TRACT -S.y.L ............... <br /> Owner's Name -...13.- Dalen. - - ----- ........ ............ --..._.------------... ---- --- ------------ ....Phoneg.-5''1--.20-27------ ----------- <br /> Address . <br /> -- ----.-- <br /> Address .--. Cit Stkn, <br /> 7620._. 0..-.-yl?Dorad.a _..... . .... ...... .... ....... __-.-..._ y - --...- ------- - ------ -.-..-.....-....------ <br /> B1a.eka-rd' s Septic Tank 26 <br /> Contractor's Name -- - - - ----- - . - . . ...._ ..... .. License # ..... -...._95� Phone _463:,!.7_0,4.e___ <br /> Installation will serve: Residence [3 Apartment House❑ Commercial []Trailer Court ❑ <br /> Motel ❑Other . ........ ..... _..---.._.------- <br /> Number of living units: 1 Number of bedrooms --.2_.._.Garbage Grinder ............ Lot Size ........4Q...Ar,ras............... <br /> Water Supply: Public System and name _ --------------------------------- ..................................................... <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 rexerse 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--------51X0/ X10 ' Liquid Depth ..� .�.....:.......... <br /> Capacity ...-----1200-----0_.. Type sq� .......- Material-.--. on,�_-: -- No. Compartments ----2............... <br /> Distance to nearest: Well ..................__Fot?ndation' 1.0'._-- ..... Prop. Line __ -------2GO-Ii..- <br /> LEACHING LINE No. of Lines . . Length of each line;:..._._50_1_... Total Length ........10.1[gid 2. ... �-- _ _ g - 9 �. <br /> 'D' Box 1 Type Filter Material -_--.---._:Depth Filter Material .............19'.'-.____..-.............. <br /> . <br /> Distance to nearest: Well _11Q.'..-......... Foundation 2.0-'--- _ -- - -- Property Line -1000 <br /> SEEPAGE PIT ( � Depth _ �'_. -_ Diameter .33......._.. Numbe- 2 <br /> ?- .. ..... Rock Filled Yes :E] No C � <br /> Water Tabl@ Depth -----------------90.........................:.Rock Size ...--------all-------------- <br /> Distance to nearest: Well -----------10.0.....................Foundation _.-_--..CSO-'...... Prop. Line .......I.OG&t_.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit* .................................... . Date .-...................._.-_._..----) <br /> Septic Tank (Specify Requirements) . .. ... 1200 Gal. <br /> Disposal Field (Specify Requirements) __1.00_-.....L•eac-h-.title. & _(-2). -Pits -.__T-'-X25 ------•------- <br /> _ _ _ ...... .._...... ............... ..............- .. . --- ...................................----------------- ------- -- <br /> ..--•------......... _...__...... . ....... - -- ---- -•-•-----...._..._... . ..... ... .........---- --------------------- <br /> (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 .................. , _ _ _ Owner <br /> � � Contra.ctor <br /> By . ���. .. f1r:�'.. _- �-{ � � ----------------- Title _--- .. ........ -. .._ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -�YJ'l .......................................................... .. DATE ./ 7­3............... <br /> BUILDING <br /> ATE .y©.. ..3-".Z-.3---•--•----••-- <br /> BUILDING PERMIT ISSUED ---------------------------------------..................... ____-.-_DATE . <br /> ADDITIONALCOMMENTS .....................................................•------•----._._...._.;...---••---•-•--____------_- -_-----. ---__-...........................--....... <br /> ..............._.._.......•--••----•--..._:_. <br /> ----•-- ------ .......------•-...............-_............................................... <br /> ----------------------- <br /> Final Inspection by: -. _-✓r'J"_ -..........__. Date rp____ -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M 'Y`� <br />