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='FOR OFFICIO USE: <br /> E APPLICATION FOR SANITATION PERMIT <br /> _ <br />•-C-'.. .-K.d-'..................... <br /> ' iNo. 7M ................ Permt ./.......`.�..9..• <br /> --- <br /> v complete In T4111cotoV <br />....................................................... Date !$sued <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 herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: � <br /> f , <br /> Y JOB ADDRESS/LOCATION .. W.lf.. ��lac:..�r li'.._...Zdo.�. -5 a4�1� .,r1y&CENSUS TRACE .......................... <br /> Owner's Name ... .--9.....�ra_ t<"�,c►fiI?Ef .............................r•---....------.:....:.._............•Phone._..,? <br /> Address .................. .........4 <br /> ........................:City ....-•--•----•-----•....... ........................_ <br /> -..--..._ �.. .. E <br /> Contractor's Name ----9:4, r-K- ' .: ._..License # G°.�7�.._ Phone... <br /> A4 � t'l.S <br /> Installation will serve: a Residence @ErApartment Housefl Commercial E]Traller Court 0 _ # <br /> s Motel ❑Othei............................................ �._....�.. "" <br /> i <br /> Number of living units:........ --- Number of bedrooms `_'::>::...Garbage Grinder ............ Lot Slze .. <br /> ... d�:: : 1.. 7 ' <br /> Water Supply: Public System and name ------------ .................. .............:.._...Private <br /> --------•-----.......,...................•-........_................. i <br /> Character of.soil to a depth'-Of 3 feet:�`Sand-t3 Silt Q Clay 0`_Peat❑ Sandy Loam 0 - Clay Roam ❑ <br /> 4 .Hardpan 0 Adobe j] Fill Material ............If yes,.type............... ............. � <br /> (Plot plan, showing size of lot, location of system in rotation to wells, buildings, etc. must be placed on reverse side.}:. <br /> NEW INSTALLATION- (No septic tank or seepage p t permitted if c�seweri l available within 200 feet, <br /> • � pP Pe 1 <br /> PACKAGE TREATMENT f ] SEPTIC TANK ] Size-•-. .... .... .. ....... .............. Liquid Depth ....__....___. <br /> `. 8 - •_ <br /> Capacity --- --------------- Type ----•............ -..Materlai 'Ci? rfx:/..-._No._ Compartments ---.....--------...... <br /> ' Distance to nearest: Well 7� y......Foundation p. . <br /> �- /�• ------- .................. ...................,.. Pro ._.. ........... <br /> . �-� Une Wit? <br /> LEACHING LINE [ ] No. of Lines;�'r�/=�k-_4.aAength of'each line.............................. Total --Length I <br /> 'D' Box.......L_ Type Filter Material f:7E'�':`.K1 ipth Filter Material . _ ./f......::........................ <br /> Distance to nearest- Well ��- .-.. Foundation- '% '-- Property-lane.... �._ .....:1► <br /> --- <br /> SEEPAGE PIT [ } ? Depth , ..e�.y-.---... Dlameter .." Num! er --------------- -�-• Rock Filled Yes [� No <br /> Water Table Depth ----------------- ...........................Rock Size .........,...................... <br /> Distance to nearest: Well -------------1°`:---.--_----_:._Foundation ............. Prop. Line ......_............. <br /> REPAIR/ADDITION(Prov:-Sonitation-rPermit.#`__ ................................• Date ................................. <br /> Septic Tank (Specify Requirements).-.......... .... - r - ,�....--•----.... .X........ <br /> Disposal Field JSpecify Re uirernentsl .... r .. .. � <br /> ................. .•---. ....... ------------------------------------------------..................-•---•....._----•---........... - I <br /> ............. -----------------•---•-----•-----•--- -----•-•-•--•-----------•--•-----•-----=--......._.............._...•--•_ .......•--........._....•---•--•-........_.................. <br /> s IDraw existing and required addition on reverse side) <br /> i <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin I <br /> t <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health:District. Home-owner or Been- <br /> sed agents signature certifies the following: `y <br /> '_'.l_cerhfy that In-the performance of the work for which this permit is Issued, l shop not employ any Person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed . ........ i* ---------------------------------- ------- Owner <br /> BY --------------------------------------------------------- .............--------- -Title ............................ ........................................... <br /> (if other than owner) _ ,_ •. _ ffi} P . <br /> DEPARTMENT Cie ONLY <br /> APPLICATION ACCEPTED BY ------ :- .... DATE___ .. _ . <br /> BUILDING PERMIT ISSUED ------- ..:..... .. - ---------- DATE ---------•--......... --. n. <br /> ADDITIONAL,COMM NTS �. ....- .... <br /> y �L <br /> �i. ''. - cc ------------- <br /> .... .. . -. -•------------ •-.............. ---- ----....-------------------••-------•--.._..-... <br /> •----------•.... ................. ...... .............. .... ...•- -- <br /> Final Inspection by: ... ....----...Date . <br /> ' ER 13 2h 1-68 Lev. ;. SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M <br />