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-4„r <br /> .. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> f Permit No. 7_�--- �---- <br /> ----- ---------------- - - ----- ---- <br /> ---- ----------- (Complete in Triplicate) <br /> Date Issued <br /> -- -- ----- --- ---- -- ------ -------------- <br /> This Permit Expires 1 Year From Date Issued <br /> he work herein <br /> Application is hereby made to the San Joaquin n°e with Cou pyt�Ordct inance a permit <br /> and existing Rules fiand t Regulations- <br /> I described. This applicat'on ' made in comp <br /> ;; CENSUS TRACT ------------------------- <br /> 3 <br /> - --- ----.. <br /> 108 ADDRESS/LOCTN . _Lberg--Rn- 1�8_-mita ° --99- <br /> - ------------- <br /> Phone 368-9135 <br /> Owner's Name _Lox'en--harry--------------------------------------------------------------- <br /> -- ------- ------ --------- --------------------------->------ -Lod1 <br /> City ---------------------------------------------{9-16_}---------•----_-- v <br /> ------------------ 483-847( <br /> Contractor s Name O lr)NeS 181784 Phone - -2.107 <br /> y ----- <br /> ----------- <br /> .. r1'1_ _�an��&-t0Y1�,--�-ne---=-'�-'�----.License # ----- -- :�,...-�'` <br /> Installation will serve: Residence [R-Apartment House-[] .Commercial=�7railer Court-❑-- . <br /> t• ;, ( <br /> *Motel Otlier F.---------------------------------------- E <br /> 196t, x 290' <br /> Number of living units:---1------ Number ofrbedrooms _,_--` --Garbage Grinder ------ Lot Size ------------------------ ------- ------- <br /> Public System and name }_ - <br /> ----Private C <br /> Water Supply: Y � � '� `y� --� t �..��.�� k���: I <br /> Character of soil to a depth of 3 feet: : Sand b ` Silt❑ Clay❑"`Peat �y;Sandy Loam Clay Loam;[] <br /> Hardpan ❑ Adobe-[] Fill Material -----------_`If yes,fiYPe <br /> ------ <br /> tion of s stem in relation to wells, buildings, etc. must be placed on reverse side:} <br /> (Plot plan, showing size of lot, Iota Y I <br /> NEW lN5TALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200,�eet,1 <br /> j Li quid De th - ------ --------•------- <br /> PACKAGE TREATMENT { I SEPTIC TANK'[ 1 Size-----rQund---- 11.1---l9�tg._ q P 1- <br /> Ca acct ' 1500 Type -FiberglSM&erialFiber-glaS$Vo. Comparmen <br /> tts ---------------------- Ul <br /> Distance to nearest: Well -----50'------------------------Foundation -___-lOt--___---_ Prop. Line --45_'___--__.----- r <br /> loot ------ Total Length _200-1--•---------------- n' <br /> LEACHING LINE [ ] No. of Lines -----9'c------------------- Length off e, line----------------- - <br /> D' Boxas I <br /> : ------ -- Type Filter Material gr ve-I---•Depth Filter Material --_19-1---�-----••---- <br /> Distance to nearest: Well --60'------- ---- Foundation -2 '----------- -- Property Line -- -------No ---- <br /> A <br /> SEEPAGE PIT [ ] Depth <br /> _251:---------- Diameter _3-._-___----- Number ---------------------------- Rock Filled' Yes ® No :[1 <br /> Water Table Depth Rock Size ------------------------------- <br /> P ------------------ ------ ------------------- <br /> 160t ----------Foundation _._11-- -------- Prop. Line _.6?�------•----- <br /> Distance to nearest: Well -------------- - <br /> 1 r <br /> ' ------ ----- Date ---------------------------------- <br /> REPAIR/ADDITION(Prey. Sanitation Permit ------------------ - - -- - -- <br /> Septic Tank (Specify Requirements) - ------------------------------- <br /> Disposal Field {Specify Requirements} ---------------------- <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 /> er or licen- <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home own <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> ' as to become subject to Workman's Compensation laws of California." <br /> -Vde rn a atio InC: owner - <br /> .... . <br /> signed _ 4 ------ -- ------------------- _.. <br /> g <br /> T'resi ent <br /> ---------- Title --------�------------ ---- --------- ---•-- <br /> ---------------------------- <br /> --- -- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> i DATE/P-1 _�_ . ------------- <br /> APPLICATION ACCEPTED BY _..__ - _ -- <br /> - - <br /> BUILDINGPERMIT (SSU ------ ------- --- ----- --------- ------------------- ----- - ------ -------------------------------------------------- <br /> ADDITIONAL <br /> -- --------- -=-------------- ------- ---- <br /> ADDITIONALCOMMENTS ---------------------------------------------------------- ---------------- ------------------- -------------------- ------------- --------- <br /> ------------------------------------- <br /> --------------------------------------------------------------------------------------- <br /> / --- - <br /> - -- -- ---- = Date �/ _. <br /> Final Inspection b ----------------------- <br /> -- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.-9 1-'68 Rev. 5M, - N_ <br />