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, FoR OFFICE`USE: <br /> APPLICATION FOR SANITATION PERMIT _ 53 <br /> tComplefe in Tdplicatel <br /> Permit No. ..7......�-.... <br /> This Permit Expires 1 Year From Datelssued Date Issued ...._:. .7._ <br /> Application is hereby made to the Son 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 /> f <br /> JOB ADDRESS/LOCATION .10P�P_p . ...... .......... ..................... .............................CENSUS TRACT ._....._. ................ <br /> t <br /> Owner's Name ---...-- .. .......... --•-•............................... .:_ ..........Phone...............................---- <br /> Address -....- ..-..�u-.li .. City <br /> Contractor's Name '+----- , k ._...- --- .........License # _ .� ` Phone .............................. } <br /> Installation will serve: Residence[Apartment House Commercial{]Trailer Court C <br /> Motel ❑Other -•------•-----------•------ ---------------- <br /> Number of living units:....../.-.. Number of bedrooms _;�!......Garbage Grinder ........:... Lot Size ..M.�_�.......•......................:.... <br /> Water Supply: Public System and name ---------------•-•:---- ........................ ••------•---•,-.........................................Private gr <br /> Character of soil to a depth of 3 feet: Sand Silt❑ ClaY ❑ Peat❑ Sand Loam flCla Loam <br /> ❑ <br /> Hardpan(If Adobe 0 Fill Material ............ if yes,type............... :........ <br /> ... (� <br /> n (Plot plan, showing size of lot, location of system In relation to~wells, buildings, etc. must be placed on reverse side.) <br /> l 7� <br /> NEW INSTALLATION:' (No septic tank or seepage pit permitted if ublic sewer is available within 204 feet,) <br /> PACKAGE TREATMENT i� <br /> [ ] SEPTIC TANK le Size.....•--a-..�..T....,#..�.--....... Liquid Depth �................. <br /> _ n- <br /> Capacity,. .Q4_-- Type •--_•_-� Material..-�'4-! -.... No. Compartments -' ----.._..---•• <br /> Distance. to nearest: Well ............5.0 "------------Foundation ......./0---.-.--_ Prop. Line ..... <br /> LEACHING LINE [� No. of lines .---TI............• Length- of each line--:...�40. ..._ _ Total Length ..... <br /> 'D' Box.... I-------.. Type Filter Material ..----.Depth Filter Material ... .......................... . <br /> Distance to nearest: Well -.-...J._a .jam' Foundation ..-... �- .... Property Lina ... �. <br /> SEEPAGE PIT [` Depth _-_-x;_4 . Diameter � �` - Number .........- <br /> � -------------- - .�------ <br /> ��•------- Rock Filled Yes groo"No (3 <br /> Water Table Depth -----..._ 40 -----------------------Rock Size -•-----= <br /> Distance to nearest: Well .............1..Sa. 17 -Foundation .---4 . Prop. Line ..�'.r1�:: <br /> _______ ..... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................... ------ Date _-_ ...................... <br /> SepticTank (Specify Requirements) .......................................:...........................................:.............................:............................ <br /> Disposal Field (Specify Requirements) ------- --------------........................................-•................................................................. <br /> ... <br /> ------- ------------------------------------------ _..•-•-••----.-..............................................---•-•.......................... <br /> IDraw,existing and required addition on reverse sidel <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 /> BY -------•---- ---- .. ._ Title ► - ...: <br /> (lf other than owner) <br /> POR DEPARTMENT USE NLY <br /> APPLICATION ACCEPTED BY ...C_."---- ------ - DATE . Y 7�.7. . .. ------------ <br /> BUILDING <br /> - . . <br /> ----- - <br /> �......:::............DATE . .-................ <br /> Bti1LD1NG PERMIT ISSUED -----.........•------.........------------ ----.....-....-.-..._.._ ...............--...--- <br /> ADDITIONAL COMMENTS ......................................................... .-... - = /.. <br /> -------------- --------------------------------------------__---------... ----------•----...__-_ _----- --•------_........_...-._.-..Z---•------------------- <br /> ...--------• ---------------------•---- <br /> t ,• <br /> ...... ......... <br /> f=inal Inspection by: Date . .. .- .--. .--.-, <br /> .....- <br /> EH 13 24 1-68 zay. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7$ 3M <br />