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:FOR OFFICE USEk <br /> EICATION FOR SANITATION PERMIT r32 <br /> ;�; .. ............ Permit No�� <br />.... ......... (Completeln Triplicate) <br />....................................................... W _- . 77:.�Date Isauad _ ?•7 <br /> This Permit Expires 1 Year From Date Issued <br />. Ith District for a permit to construct avid install the work heroin <br /> Application is hereby made to the San Joaquin Local Hea <br /> described. This application is made'.In complian'c'e'with County Ordinance No. 549 and existing Rules and Regulations <br /> JOB ADDRESS/L 7Q. .,�•t.c•. �................ ....CENSUS TRACT ................. ..............TIO <br /> ............... .. ..... 4 <br /> Timet <br /> :. .s,J. ...........:Phone ...... ............. ... . <br /> Owner's Name ¢ ... yam- E <br /> ...........t City ..... ...............:........................ <br /> Address f <br /> i 1 ...:.........license # d .. . ...�.... Phoneme, <br /> Contractor's Name ... . ....................� ..... . ...... <br /> Installation will servsisidance rC3trnent House Commercial OTraller Coot 0 <br /> Motel❑Other <br /> • <br /> Number of livi rg uniw ...----.... Number of bedrooms ...�5.•-•-Garbage Grinder ............ Lot Size ...................... . ......... . <br /> Water Supply:Ah-blic System and name ..................-------. . ................... ........................................ ........ 13 <br /> l+rhrats <br /> Character_ f soil,to a depth of 3 feet: Sand® Slit E3 Clay p Peat Q Sandy Loarm fl Clay Loam <br /> o <br /> ' Hardpan Adobe[j Fill Material ............if yes,type ............... ............ 1 <br /> (Plot plan, showir3g slie of lot, location of system in relation to walla, <br /> butldings, etc. moat be placed an reverse. side.? <br /> NEW INSTALLATION: <br /> (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> SEPTIC TANK Size. Liquid Depth ..............:.......... <br /> PACKAGE TREATMENT ( . ................................. .. ...:.� <br /> ..� Material.. <br /> ....................... Compartments <br /> b. i r Capacityl),A . .� ........ - � 6 <br /> Distance to nearest: Well 115 --. ...:...........Foundation <br /> Prop. Line ......�... : � <br /> LEACHING LINE D of lea .--•---- �-: Length of each I no.................... .... Tota) Length ............:.............. <br /> ' ., 1 .Depth Filter Material'i <br /> D. 6ox fi Typeiiter Materia ill r Ma .11 .............................:� <br /> nearest: We ............ .... Foundation .................. ....Property line .. . .. ... ,.... <br /> Distance to II _ . �' k Filmed Yes.❑ No <br /> Diameter .. Number ..:.:.................. 4 <br /> (31 <br /> SEEPAGE PIT p .:. ..- <br /> Water Table Depth ........................ ..Rock Size - ... .................. �` ..........r <br /> t Pro tins` <br /> Distance to nearest: Well --~ .................•--•..__.........Foundation ..:................ 1?• -- <br /> ItEPAIR/ADDITION)Prev. Sanitation Permit ..........................................:. Date ..... _.... .... -) <br /> Septic Tank ISpecify Requirements) .. .............................................. -`- •-- •• ......._.................. .k <br /> Disposal i=telci {Sliecify Requirements) " .-�:. :! A: 4er <br /> t �............. . .... , .............................. <br /> ..._...............................�_._..... ........................................... <br /> ... .. _. <br /> .......... ........ -- reverse side) <br /> iDrow existing and required addition an <br /> I hereby certify that I have prepared"this'app11cation and that the work will ba done In aec trio. a with $ee► Boit+ <br /> County Ordinances, State laws: t:nd Rules and Regulations af.the San Joaquin Local Health District. Horne owner or )item• <br /> sed agents signature teolfies the following:. � j ' <br /> ,I certify that in the perforrmanca`of the work for which this permit Is Issued, I shall not employ any persoR Irl such manner <br /> as to bacon su act tv rkman's Compensation laws of Califonia°' : <br /> ' Signed .. <br /> .Owner <br /> By ....................................r .... ... ..... - Title ............ ......-...y .. <br /> )if other than owner) <br /> FOR DEPARTMENT USE'ONLY <br /> APPLICATION.ACCEPTED: BY.... . . ............. <br /> DATE ... .........�.�......... <br /> BUILDING PERMIT ISSUED .......................... <br /> .DATE .:: :...;...,.:.............. ..•. <br /> ADDITIONAL COMMENTS ---•-•-----.............................................................:._..............-... <br /> ......-...- <br /> ............. . ....... <br /> ........................................ •-- .bate ..1.--�....._c�� -..._..... <br /> Final inspection by: ...... <br /> .... .... ldrj....--._ ..................... <br /> EH J.3 24 1-68 . Rev. $l: SAN JOAQUIN LOCAL HEALTH DISTRICT ��? � <br />